Medicare Compliance & Reimbursement

Even though the 2021-2022 flu season just commenced on Aug. 1, one Medicare carrier is already seeing an abundance of vaccination claims with the wrong CPT^® codes.

Details: “National Government Services has noticed a large amount of claims being billed for the 2021-2022 flu season with the incorrect CPT^® codes for influenza flu vaccines,” the Part B Medicare Administrative Contractor (MAC) notes in a Sept. 27 release. The National Drug Codes (NDCs) change annually, too, and they “must be included in Loop 2410 LIN segments of the electronic claim (Item 19 on the CMS-1500 paper claim). Each box of vaccine includes the NDC assigned by the manufacturer,” the release says.

When the NDC and CPT^® codes are wrong, the claims are denied. Practices should also remember to use HCPCS code G0008 (Administration of influenza virus vaccine), too, to ensure claims are processed correctly, NGS reminds.

Review the Centers for Medicare & Medicaid Services (CMS) seasonal vaccine payment guidance at www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.