MedicaidCoverageMedium impact
BT202196: IHCP adds coverage for COVID-19 vaccine counseling, effective Nov. 2, 2021
Indiana Medicaid (IHCP)·IN·Medical Policy
Effective date
Nov 2, 2021
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) now covers COVID-19 vaccine counseling using CPT 99401 with modifier 25, reimbursing $28.92 per 15-minute session for unvaccinated members ages 6 months and up. Coverage applies to eligible providers including physicians, physician assistants, and advanced practice nurses.
Action Required
Immediately: Billing team must add CPT 99401 with modifier 25 to billing system for COVID-19 vaccine counseling sessions. Set reimbursement rate at $28.92 for professional claims. Restrict to one unit per day per unvaccinated member per provider. For telehealth services, add both modifiers 25 and GT. Update encounter forms to include this option for eligible providers (physicians, PAs, and APRNs except CRNAs).