NC Medicaid providers to be reimbursed for COVID-19 vaccine counseling

RALEIGH - To help Medicaid beneficiaries get the accurate information they need to make an informed decision about getting the COVID-19 vaccine, the North Carolina Department of Health and Human Services will reimburse Medicaid providers for providing counseling on the benefits of COVID-19 vaccination.

NC Medicaid providers can now be reimbursed for up to 15 minutes for preventive medicine counseling and/or risk factor reduction intervention provided to an individual related to COVID-19 vaccination when provided to Medicaid beneficiaries. Many children do not yet qualify for the vaccine, but their family members do. Parents or guardians of children receiving Medicaid – even if they are uninsured – can also receive counseling from their child’s doctor. Medicaid providers will be reimbursed for this counseling as well.

"It is our hope that other payers will adopt this additional reimbursement to acknowledge the time and effort front line practices are investing so that more COVID-19 vaccine makes it to North Carolinians before flu season arrives," said Dr. Shannon Dowler, Chief Medical Officer of Medicaid at NCDHHS.

Research done nationally and in North Carolina shows medical professionals are one of the top trusted sources for information about COVID-19 vaccines. With many North Carolinians still having questions about the vaccines, the additional payment for counseling will support health care providers in taking the time needed to understand a patient’s concerns and answer their questions.

NCDHHS has a toolkit to help health care providers promote vaccination within their practices. Healthcare providers are encouraged to use the materials to encourage patients to get vaccinated.

There is increasing urgency for people to get vaccinated against COVID-19 as the more dangerous new Delta variant is rapidly spreading in the United States, including in North Carolina. The Centers for Disease Control and Prevention classified the Delta variant as a "variant of concern" because it spreads faster than current COVID-19 variants. Early data have also shown a possible increased risk of hospitalization in people infected with the Delta variant. The currently available COVID-19 vaccines are the best protection against the virus and its variants.

More information is available in the special bulletin about NC Medicaid’s new reimbursement code.