Update to Health Check Services for Georgia Medicaid

On 4.1.2013, Georgia Medicaid posted the provider notice below regarding an update to their Health Check (EPSDT) services. The notice provides guidance on billing vaccine administration codes along with the necessary modifiers in conjunction with Health Check services.  Please note that DCH indicates that “health check providers may adjust or resubmit immunization claims for dates of service on or after January 1, 2013, in order to receive the vaccine administration fee for vaccines administered on or after January 1, 2013…”

Once DCH publishes any update or change to traditional Medicaid, the CMOs generally have 45 days to implement into their own systems.

Dear EPSDT Providers:

Effective April 1, 2013, the Diphtheria and Tetanus toxoids (DT) vaccine (CPT code 90702) is no longer reimbursed under the Health Check program.

Beginning April 1, 2013, providers should bill any and all of the following appropriate vaccine administration codes, when administering VFC vaccines to children 18 years of age and younger, as they apply: 90460, 90471, 90472, 90473, 90474. The ICD-9 diagnosis code v20.2 may be used when vaccines are administered during the Health Check visit. Additional details regarding the vaccine administration codes and reimbursement are contained in Appendix C of the EPSDT (Health Check Services) Manual, updated April 2013.

Beginning May 1, 2013, Health Check providers may bill the Health Check program for vaccines administered to members nineteen (19) years of age through twenty (20) years of age. Include the vaccine CPT and diagnosis codes along with a vaccine administration code on the Health Check claim. This means that the ‘EP’` modifier must be used with all codes so that our MMIS recognizes the claim as a Health Check claim. The Division will reimburse providers for the vaccine product (providers must use their own stock of vaccines) and for each vaccine administered at a rate of $10 per vaccine administered. Health Check providers may adjust or resubmit immunization claims for dates of service on or after January 1, 2013, in order to receive the vaccine administration fee for vaccines administered on or after January 1, 2013, however, the appropriate vaccine administration code must be included on the claim.

Providers will be notified when the ACA increased rates are applied, and the rates will be retroactive to January 1, 2013.