90471, 90649 vs 96372

Patient brings in Gardasil from pharmacy and receives injection by MD. Bill:


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bkoemm

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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 has gotten denied from the insurance. Upon further review, 90471 is required to be billed out with the 90649 (which may be why it denied). However, if our office is not providing the Gardasil, how than would we code the visit? Thank you!
 

CodingKing

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90471 $XXX.XX

90649 $0 or $0.01 depending on whether your system can handle $0 charges or not
 

Cmama12

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Yes you still have to bill the 90649 - we have a modifier that we use for patient supplied meds that zeros out the fee.
 
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