Effective Oct. 22, 2021, NC Medicaid-enrolled providers can bill code 99401 with HM modifier for telephone outreach to unvaccinated Medicaid beneficiaries. The goal of the outreach is to educate the beneficiaries on the vaccine and assist them in scheduling an appointment, ideally in the office where the outreach is originated.

Billing Specifications:

• CPT 99401 HM has a limit of one call per beneficiary per day. The code can only be billed for successfully connecting with the beneficiary; hangups or voicemails cannot be billed.
• Medicaid-enrolled providers must bill CPT 99401 HM with a CR modifier to indicate a PHE code.
• There is no requirement for a specific diagnosis code associated with the code.

This outreach service can be provided by members of the office staff of the MD/DO, NP, PA or CNM and if provided at LHD, FQHC or RHC will be reimbursed outside of the PPS rate. The NPI of the provider present at the office will be the rendering provider on the claim. 

For scripts and other information see the special bulletin