How To Use HCPCS Code G0315

HCPCS code G0315 describes immunization counseling for COVID-19 provided by a physician or other qualified healthcare professional for individuals under the age of 21. This code is specifically used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. The counseling session typically lasts between 5 to 15 minutes.

1. What is HCPCS G0315?

HCPCS code G0315 is a specific code used to identify immunization counseling services provided to individuals under the age of 21 for COVID-19. It is important to note that this code is only applicable for the Medicaid EPSDT benefit and cannot be used for other purposes.

2. Official Description

The official description of HCPCS code G0315 is “Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 5-15 minutes time.” The short description for this code is “Counsel immune <21 5-15 m."

3. Procedure

1. The healthcare provider initiates the immunization counseling session for COVID-19.
2. During the session, the provider educates the patient or their guardian about the importance of COVID-19 immunization.
3. The provider discusses the potential benefits and risks of the vaccine, addressing any concerns or questions the patient or guardian may have.
4. They also provide information on the vaccination schedule, potential side effects, and any necessary follow-up appointments.
5. The counseling session typically lasts between 5 to 15 minutes, depending on the specific needs of the patient.

4. When to use HCPCS code G0315

HCPCS code G0315 should be used when providing immunization counseling specifically for COVID-19 to individuals under the age of 21. It is important to note that this code is only applicable for the Medicaid EPSDT benefit. Providers should ensure that the counseling session meets the time requirements of 5 to 15 minutes to accurately report this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0315, healthcare providers need to document the following:

• Date of the counseling session
• Duration of the counseling session (between 5 to 15 minutes)
• Provider’s name and credentials
• Patient’s demographic information
• Details of the counseling provided, including education on COVID-19 immunization, benefits, risks, vaccination schedule, and potential side effects

Providers should ensure that the documentation supports the medical necessity of the counseling session and the use of this specific HCPCS code.

6. Historical Information and Code Maintenance

HCPCS code G0315 was added to the Healthcare Common Procedure Coding System on May 11, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0315 is not payable by Medicare, as indicated by the coverage code I, which means it is not reimbursable by Medicare. The pricing indicator code for this code is 99, which indicates that the value for this code has not been established. Additionally, the multiple pricing indicator code is 9, which means that this code is not priced separately by Medicare Part B.

8. Examples

Here are some examples of scenarios where HCPCS code G0315 may be billed:

1. A 16-year-old patient visits their pediatrician for a routine check-up. During the visit, the physician provides counseling on the importance of COVID-19 immunization, addressing the patient’s concerns and providing information on the vaccine. The counseling session lasts for 10 minutes. In this case, HCPCS code G0315 can be billed to report the immunization counseling service.
2. A 19-year-old individual visits a community health center to receive their COVID-19 vaccine. Before administering the vaccine, a qualified healthcare professional spends 7 minutes counseling the patient on the benefits, potential side effects, and the importance of completing the vaccination series. HCPCS code G0315 can be used to report the counseling service provided.
3. A 14-year-old patient visits an allergist for a consultation regarding their allergies. During the visit, the allergist takes the opportunity to provide immunization counseling for COVID-19, explaining the vaccine’s benefits and addressing any concerns the patient or their guardian may have. The counseling session lasts for 8 minutes. In this case, HCPCS code G0315 can be billed to report the immunization counseling service.
4. A 17-year-old patient visits a family physician for a sports physical. As part of the visit, the physician provides counseling on COVID-19 immunization, discussing the vaccine’s efficacy and safety. The counseling session lasts for 12 minutes. HCPCS code G0315 can be used to report the immunization counseling service provided during the sports physical.
5. A 20-year-old individual visits a college health clinic to receive their COVID-19 vaccine. Before administering the vaccine, a healthcare professional spends 6 minutes counseling the patient on the importance of vaccination, addressing any concerns or questions they may have. HCPCS code G0315 can be used to report the counseling service provided.