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Coverage of Vaccine Counseling Services for EPSDT-Eligible Members

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Effective Date:

All Providers and Managed Care Organizations Participating in the Virginia Medicaid and FAMIS Programs
Cheryl J. Roberts, Acting Director Department of Medical Assistance Services (DMAS)

The purpose of this memo is to inform providers that DMAS and all managed care organizations (MCOs): 1) will cover a stand-alone billing code for COVID-19 vaccine counseling services through the last day of the first quarter that begins one year after the last day of the COVID-19 emergency; and 2) affirm coverage of non-COVID-19 vaccine counseling via existing well-child and preventive care billing codes for all full-benefit Medicaid members under 21 years of age. Corresponding changes have been made to the EPSDT Supplement (Supplement B) and Chapter IV of the Physician/Practitioner Manual. This coverage is consistent with Section 9811 of the American Rescue Plan Act of 2021 (ARPA). Further contact information is included at the bottom of this document. For prior memos outlining DMAS COVID-19 vaccination coverage, please visit:



Virginia Medicaid Web Portal Automated Response System (ARS)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

Medicall (Audio Response System)

Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice.

1-800-884-9730 or 1-800-772-9996


Service authorization information for fee-for-service members.


Provider Appeals

DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal.

Managed Care Programs

Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE).  In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider.  The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals.

Medallion 4.0

CCC Plus


Magellan Behavioral Health

Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members.

For credentialing and behavioral health service information, visit:, email:,or

Call: 1-800-424-4046


Monday–Friday 8:00 a.m.-5:00 p.m.  For provider use only, have Medicaid Provider ID Number available.



Aetna Better Health of Virginia


Anthem HealthKeepers Plus


Molina Complete Care


1-800-424-4524 (CCC+)

1-800-424-4518 (M4)

Optima Family Care


United Healthcare


1-844-752-9434, TTY 711

Virginia Premier

1-800-727-7536 (TTY: 711),