On October 1, 2021, the Centers for Medicare & Medicaid Services (CMS) changed a procedure-to-procedure edit from modifier indicator 0 to 1. After joint work between CMS and the American Academy of Pediatrics, CMS agreed to this change to allow for reporting of code 99211 if the patient presents for a nurse-only vaccine encounter and also requires a COVID-19 test.

Modifier 25 is required with 99211, which means there must be documentation to support code 99211 as a separate service and it may never be used for a vaccine-only visit. CMS will revisit this decision at the end of the public health emergency. For more information, visit https://downloads.aap.org/AAP/PDF/AAP%20Position%20Paper%20EM%20IA.pdf.

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