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Wiki 90460 and 90461 Reimbursement issues

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IshratKhurshid

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We are having issue with immunization admin procedures 90460 and 90461, Florida Medicaid HMOs (Better health, Sunshine, Molina health, Wellcare/staywell Amerigroup etc) keep denying 90460 and 90461 with the reason as unlisted procedures in Medicaid fee schedule. All vaccines are getting paid, only immunization admins are getting denied.. we tried to file dispute/appeal but didn't work.
are there any other specific codes for such insurances, or we have no choice other then write off these procedures?

Thanks!
 
Florida Medicaid does not reimburse for the admin codes it seems they bundle the reimbursement into the vaccine

Found some info in the following thread:

https://www.aapc.com/memberarea/forums/51538-90460-90461-denials.html

UHC Community plan has a comment about Florida:

https://www.uhccommunityplan.com/co...cies/Vaccines_for_Children_Policy_(R7109).pdf


Florida pays on the serum code rather than the vaccine administration code.The administration code is not required to be on the claim.
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