Wiki 90560 and 90461

[blondie12]

We recently recieved a letter from united healthcare community plan stating they are no longer paying for 90460 and 90461? What should we use in the place of these and is this true for all insurances or just this one? Thank you.

 

[KERRIEA]

We are still getting paid from UHC for these admin fees. I would have your practice manager contact UHC and find out the reason.

 

[shellysk8]

What State?

I know that certain State FFS Medicaid plans do not cover those codes, and pay the other vaccine administration codes instead - 90471-90474. I believe that NJ is one of those. Also, many state Medicaid plans will no longer be covering 90461 due to the PPACA legislation, and are only paying 90460. A few other states do not cover the vaccine administration codes for VFC at all, and pay on the serum codes instead. UnitedHealthcare is following the State-specific regulations which will vary depending on which state you are billing in.

I hope this helps!
Shelly

 

[ssalandy]

90460 and 90461

As of January I am having trouble using the administration code 90460 for immunization when the patient comes in for their routine preventive care it is being rejected as being bundled by BCBS. Any suggestions?

 

[shellysk8]

CCI Edits

In January, CMS added these to the Medicaid CCI edits, bundling them into any E&M or Preventive Medicine codes. This was done without any communication being provided to the provider community. They are allowed if billed with a 25 modifier is appended to the E&M/Preventive Med code. I am not sure if your problem is only with Medicaid/Medicaid HMO claims or perhaps if BCBS may have adopted these CMS edits (they have been in place on the MEDICARE side for quite a while already with the regular vaccine admin codes). Perhaps that is the issue?

Thanks,
Shelly