Wiki Billing CPT 90619 and 90620 Pediatrics

[tactikss@yahoo.com]

One Insurance Carrier is denying our pediatric claims for incorrect NDC (verified and paid by other carriers) or denied because of invalid Modifier (Mod 25 is used for the Office Visit or Well Exam because of Administration codes 90460 or 90461 administration codes) - these CPTs are administered to the pediatric patients mainly with their well-exams.
Can one carrier have different guidelines independent from others for NDCs? All the carrier response is what the EOB already states, but no clear explanation. Anyone on this one? Thank you!

 

[rthomas@impcna.com]

One Insurance Carrier is denying our pediatric claims for incorrect NDC (verified and paid by other carriers) or denied because of invalid Modifier (Mod 25 is used for the Office Visit or Well Exam because of Administration codes 90460 or 90461 administration codes) - these CPTs are administered to the pediatric patients mainly with their well-exams.
Can one carrier have different guidelines independent from others for NDCs? All the carrier response is what the EOB already states, but no clear explanation. Anyone on this one? Thank you!

One time we had a carrier want the NDC # from the box and not the individual vial/syringe. There have also been times when a carrier has not updated their system and we had to appeal every denial with proof NDC was correct until they updated their system.