90472 additional immun inj

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I am not sure if I am reading this procedure correctly. If an addtional immunization is needed we are to code 90472. The question is if the pt receives 3 immun inj are we to code 90471, 90472 x2 or x1? Can this procedure 90472 be used more than once or are all the addtional immun inj included in this one procedure 90472.
 
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164
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San Diego
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Hi,

90472 is billed for EACH additional immunization administered. For example, say there were a total of 4 immunizations given, you would bill:

90471 X1 unit
90472, X3 units

Hope that makes sense!
 
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Thanks, it does make since. We have been billing each imun inj but for some reason we are receiving denials left and right on these. I have made sure that the 25 and 59 mod is being used and that the correct dx code has been used. Main ins denials I have been receiving is medicaid and tricare. Not sure if I should be billing it differently then the other ins. Have u run across this?
 
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164
Location
San Diego
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Hi,

I looked up info on our Medi-Cal website and found out that the admin codes are different....click on the following link and read the info at the top.

http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/injectvacc_m00o03o04o11.doc

Medi-cal also makes mention of using a special modifier for children in the VFC program.

Also, read the info on the following section - it's got the exact way in which to bill vaccines to Medi-Cal and apparently, the claim form needs info in Box 19 of your claim form.

http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/inject_m00o03o04o11p00.doc

I know I'm "Medi-Cal" and you're "Medicaid" but maybe this info would help you out. Good Luck!
 
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