HCPCS G0311: Immunization Counseling When Vaccine Not Administered, 16–30 mins - OpenPayer

Summary & Overview

HCPCS G0311: Immunization Counseling When Vaccine Not Administered, 16–30 mins

HCPCS Level II code G0311 designates time-based immunization counseling by a physician or other qualified health care professional when the vaccine is not given on the same date of service. The code captures counseling encounters lasting 16–30 minutes and is commonly used in Medicaid billing contexts; nationally it is relevant for documenting preventive counseling that may influence vaccination uptake and care coordination. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise reference to what G0311 represents, why the code matters for billing and clinical documentation, and what users should expect when encountering it. Readers will find benchmarks and policy considerations related to billing and coverage (where available), an explanation of clinical context for counseling-only visits, and guidance on typical sites of service. The material clarifies where input data is limited and highlights that some payer-specific coverage or reimbursement details may vary. The focus is national and intended for clinicians, practice managers, and billing professionals seeking a clear summary of the code and its practical implications for recording immunization counseling that occurs separate from vaccine administration.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0311HCPCS Level IIimmunization counselingpreventive careambulatory servicestime-based codingvaccine counseling

Billing Code Overview

HCPCS Level II code G0311 describes immunization counseling provided by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service. The encounter is defined by a time range of 16–30 minutes, and the service is typically billed for counseling distinct from vaccine administration.

Service Type: Counseling / Preventive Health Education

Typical Site of Service: Outpatient clinic, physician office, or other ambulatory care settings where vaccine counseling occurs without same-day vaccination

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient presents to a primary care clinic seeking counseling about the human papillomavirus (HPV) vaccine series but declines vaccination during the visit because they want to review insurer coverage and speak with a partner. The clinician — a board-certified family medicine physician — conducts a focused immunization counseling session lasting 20 minutes. The discussion covers vaccine indications, benefits, potential adverse effects, schedule, and contraindications. The clinician documents informed consent discussion, vaccine lot discussions were deferred, and a plan to return for immunization is recorded. The clinic schedules a follow-up appointment or refers the patient to the immunization clinic for vaccine administration on a later date.

Typical site of service: outpatient clinic (physician office) or community health center where counseling occurs without vaccine administration that day.

Service type: immunization counseling (physician or other qualified health care professional) when vaccine(s) are not administered on the same date of service, timed visit of 16–30 minutes billed with G0311.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	Standard report when no specific modifier applies

HCPCS G2006: Post-Discharge In-Home Follow-Up Visit, 20 Minutes

HCPCS-G8661-LOW-BACK-FUNCTIONAL-STATUS-NOT-MEASURED-PATIENT-NOT-APPROPRIATE

HCPCS G8661: Low Back Functional Status Not Measured, Patient Not Appropriate

HCPCS-LEVEL-II-G9723-HOSPICE-SERVICES-DURING-MEASUREMENT-PERIOD

HCPCS Level II G9723: Hospice Services During Measurement Period

HCPCS-G0558-ADVANCED-PRIMARY-CARE-MANAGEMENT

HCPCS G0558: Advanced Primary Care Management for Complex Chronic Patients

HCPCS-G9098-ESOPHAGEAL-CANCER-DISEASE-STATUS-METASTATIC

HCPCS G9098: Esophageal Cancer Disease Status Assessment

HCPCS-G9900-MAMMOGRAPHY-RESULTS-NOT-DOCUMENTED-REVIEWED

HCPCS G9900: Mammography Results Not Documented and Reviewed

HCPCS-G1000-CLINICAL-DECISION-SUPPORT-PATHWAYS-APPROPRIATE-USE-CRITERIA

HCPCS G1000: Clinical Decision Support Applying Appropriate Use Pathways

HCPCS-G9540-PATIENT-ALIVE-3-MONTHS-POST-PROCEDURE

HCPCS G9540: Patient Alive 3 Months Post Procedure

HCPCS-G8849-REASON-NOT-PRESCRIBING-PAP-THERAPY

HCPCS G8849: Documentation of Reasons Not Prescribing PAP Therapy

HCPCS-G0529-IN-HOME-RESPITE-CARE-4-HOUR-UNIT

HCPCS G0529: In-Home Respite Care, 4-Hour Unit

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common primary care specialty providing immunization counseling
`207R00000X`	Internal Medicine	Primary care internists counsel adult patients about vaccines
`208000000X`	Pediatrics	Pediatricians provide counseling for childhood and adolescent immunizations
`364A00000X`	Nurse Practitioner	Nurse practitioners routinely provide immunization counseling in outpatient settings
`174400000X`	Public Health Nursing	Public health nurses provide vaccine counseling in community clinics and health departments

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis commonly used when counseling about vaccines and when immunization is planned for a later date
`Z71.89`	Other specified counseling	Used when the visit focus is counseling, including vaccine counseling, without vaccine administration
`Z00.129`	Encounter for routine child health examination without abnormal findings	May be used in pediatric well visits when vaccine counseling occurs and immunization deferred
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used for adult preventive visits that include vaccine counseling
`J10.1`	Influenza due to other identified influenza virus with other respiratory manifestations	May be used if counseling occurs in the context of recent or current illness affecting immunization timing
`T88.1XXA`	Other complication following immunization, initial encounter	Relevant when counseling addresses prior adverse reaction to vaccine that influences decision to defer administration
`Z79.899`	Other long term (current) drug therapy	May be relevant when counseling addresses chronic medications that affect vaccine recommendations (e.g., immunosuppressants)
`Z91.130`	Patient's noncompliance with medical treatment and regimen	Relevant when counseling addresses prior refusal or delay of vaccination and plans for future administration

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (one vaccine) percutaneous, intradermal, subcutaneous, or intramuscular; simple or single	Performed on the visit when the vaccine is administered; may be billed at a later visit when counseling occurred previously with `G0311` billed on the counseling-only visit
`90472`	Immunization administration each additional vaccine (list separately in addition to code for primary vaccine)	Billed alongside `90471` when multiple vaccines are given at the subsequent visit after `G0311` counseling
`G0008`	Administration of influenza virus vaccine	Used when influenza vaccine is administered on a different date; `G0311` applies if counseling occurred without administration
`90460`	Immunization administration by intramuscular route (includes counseling, per vaccine) — for older coding contexts	Related to vaccine administration visit following counseling-only visit
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Example of other time-based counseling codes used in preventive counseling workflows (not specific to vaccines)
`99407`	Smoking and tobacco cessation counseling, intensive, greater than 10 minutes	As above; illustrates time-based counseling coding commonly used in preventive care workflows

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