1. J

    How to Code for 4th COVID Vaccine shots?

    Hello Everyone, Because the FDA just approved Moderna/Pfizer on the 4th shot, I am having difficulty finding any materials on the subject. Based on the existing codes, I would assume the following: Pfizer: 91300 - Vaccine 0004A - Injection Booster Moderna: 91306 - Low Dose Vaccine 0064A -...
  2. C

    Question Billing/coding for covid vaccine third dose and flu vaccine at same encounter

    Hello - reaching out to see if anyone has found any specific CMS/payer guidance regarding billing for the covid vaccine and flu vaccine at the same encounter. Our practice is having trouble with Anthem processing the traditional administration codes for the flu vaccine- 90471/2 (when billed with...
  3. T

    Question COVID19 Vaccine Visits

    First time practice is billing for these. I have these codes and descriptors 91301 - COVID-19 vaccine, 100 mcg/0.5mL dose, intramuscular (Moderna) 0011A – Immunization Administration, intramuscular for COVID-19 vaccine (91301) 50 mcg/0.5mL, 1st dose 0012A – Immunization Administration...
  4. M

    Billing administration fee for non-covered immunization

    We have a patient who requested an immunization that is not covered by his insurance. We are billing the patient for the vaccine itself but can we still bill his insurance for the immunization administration since they do not cover the vaccine?
  5. A

    Refusal of immunization

    Hello, I have a visit where the parent of the child refused the HPV vaccine, (no reason given) but allowed other vaccines to be administered. Do I need to code the refusal of the HPV vaccine? Thanks ;)
  6. J

    Tricare refunds due to invalid NDC

    Someone familiar with Tricare billing: Please Help! A few months ago, our practice began receiving multiple Tricare refund requests due to "the recommended drug/vaccine dosage for the National Drug Code (NDC) units from the manufacturer has been exceeded." The claims listed were from 2013-2016...
  7. L

    NDC# denied as invalid for TDAP and Prevnar

    In the past month, our practice (primary care) started getting denials from Medicare and Bcbs for TDAP vaccine (NDC 49281-0400-15) and Prevnar vaccine (NDC 00005-1971-02), stating invalid NDC code. We had not changed anything in our system and have verified the numbers on the vaccine box and it...
  8. B

    90471, 90649 vs 96372

    When a patient requests a Gardasil immunization, the patient picks it up directly from the pharmacy. The patient picks up ONE dose of the vaccines, brings it to our office, and our MD injects the patient. Some in our office are billing 96372 w/ Z23. I recently billed out the 90471 alone and it...
  9. S

    Vaccine Modifiers

    When a patient comes in for a well visit and we administer vaccines do they need a modifier?
  10. M

    Multiple Procedure Help, please! - We had a patient in our office

    Hello! We had a patient in our office who had multiple procedures done in one day and we are stumped on how to code this. The patient received a TDAP vaccine and we administered it. The patient also had 3 skin tags removed, 2 of which are biopsies. This is what we are billing: 90715 TDAP...
  11. C

    HPV Vaccine given to patient over 26

    Hello, One of our providers gave an HPV vaccine to a patient over the age of 26. Obviously Medicaid denied the 90649 code due to patient age. In cases like this, do I just go back and tell the provider we cannot bill the HPV vaccine because of the age? Does the provider need to add an append...
  12. A

    Vaccine for children

    I live in NJ and I work for a pediatrician. We have a large number of patients with Horizon NJ Health. How do you bill the Vaccine from the state? I`ve been using the Mod SL attached to the vaccine and has been denied. Example: 90672,SL 90473 90707,SL 90472 I need help. Any suggestions?
  13. A

    Vaccine for Children Modifier

    I live in NJ and I work for a pediatrician. We have a large number of patients with Horizon NJ Health. How do you bill the Vaccine from the state. I`ve been using the Mod SL attached to the vaccine and has been denied...
  14. P

    New vaccine code for 90646 ????

    I am getting rejections for vaccine 90646 saying it is not a valid code for 2016. Any idea what is the new code for this vaccine???/
  15. M

    Billing Coordinatior

    We continue to have questions from our physicians regarding the use of 99211,The latest situation in which the physicians would like to use this code involves vaccines and the administration codes attached, namely 90460,90461 In this situation the parents have requested a "staggered" vaccines...
  16. C

    HBIG Vaccine coding help please

    I need help on how to code for the HBIG Vaccine for a patient who had a needle stick from a contaminated needle from a patient with HBV. The patient received the HBIG Vaccine and I'm not sure how to code the CPT portion? Since the cost is about 15x higher then the regular vaccine I needed to...
  17. A

    Vaccine for children

    Can somebody help me with the State supplied vaccine for children Modifier. I`ve been using the Mod SS for more than a year, all of the sudden mostly of the NJHEALTH claims have been denied for wrong Modifier. Can also somebody give an example on how to post a well visit with vaccines
  18. J

    Rotavirus to rotarix

    Does anybody know the new vaccine inj code for rotavirus which is rotarix? Thank you
  19. T

    Dreaded Vaccine Discussion

    Ok, so we are trying to make sure that we are coding correctly for Vaccines. We've just opened and never done this before. My main question is about administation fees. What do you bill if the patient is over 8 and is counseled on a vaccinations risk, etc? Also, what is different about billing...
  20. S

    ZOSTAVAX (shingles vaccine)

    ZOSTAVAX ("shingles vaccine) Does anyone have any information regarding Medicare guidlines for billing the new vaccine? ie; CPT, ICD etc.. and is anyone billing and GETTING PAID for those by Medicare and othr carriers? Thank you!!