COVID Vaccine Counseling Under the American Rescue Plan, CR 109388

Jun 13, 2022

Retroactive to the effective date of April 1, 2021, COVID-19 vaccine counseling is now a MaineCare-covered service for providers of MaineCare Benefits Manual Sections 3, 7, 14, 40, 45, and 90.  

Under the American Rescue Plan Act (ARP), the Centers for Medicare & Medicaid Services (CMS) requires states to cover COVID-19 vaccine counseling visits for families and children under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). MaineCare now covers COVID-19 vaccine counseling services for individuals under 21 years of age when billed with Current Procedural Terminology (CPT) code 99429 - unlisted preventive medicine service. Reimbursement for CPT code 99429 will be $35.46 per counseling visit. Providers billing 99429 must check this as an EPSDT service on the claim form. 

Providers may conduct vaccine counseling for initial vaccine series or booster vaccines. There are no limits to the number of counseling visits that a provider can bill under 99429. Providers should not bill 99429 during the same visit where they administer a vaccine for COVID-19 to an individual under 21 years of age. For all billing of 99429, including retroactive billing, the individual must have been under the age of 21 on the date of service. When the provider administers a COVID-19 vaccine, they should bill the appropriate CPT code for the service.   

Providers have until July 31, 2022, to submit all claims for dates of service April 1, 2021, through July 31, 2021. Please focus on the claims with the oldest dates of service first. Starting August 1, 2022, all submitted claims must meet timely filing requirements. 

Please note, 99429 is for billing COVID vaccine counseling only, and may not be used for counseling related to other vaccine types. 

If you have questions about COVID vaccine counseling, please contact your Provider Relations Specialist (PDF) with questions.