Billing MCO"s for Immunization Administration

bmore

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How to get paid by the MCO's eg. Amerigroup, Maryland Physicians Care when billing for vaccinations or immunization administration fee. They are denying all claims when billed 90471 and 90472 with modifier 'SE'.

Please advice.

Thanks
 

LOVE2CODE

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How to get paid by the MCO's eg. Amerigroup, Maryland Physicians Care when billing for vaccinations or immunization administration fee. They are denying all claims when billed 90471 and 90472 with modifier 'SE'.

Please advice.

Thanks
Remove the modifier. They will pay for the admin not the vaccine and hopefully you are billing the vaccine (VFC). If you need add'l help with this I can help you.
 

bmore

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Thanks yolanda for ur feedback. I'm not billing for the vaccines, only for the admin. So ur saying i should bill for all the vaccines and the admin. Add modifier 'se' with the vaccines but bill the admin w/o the modifier 'se'?
 

LOVE2CODE

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Alexandria, VA
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Vfc vaccines

Thanks yolanda for ur feedback. I'm not billing for the vaccines, only for the admin. So ur saying i should bill for all the vaccines and the admin. Add modifier 'se' with the vaccines but bill the admin w/o the modifier 'se'?
Yes, you should bill for all vaccines and the admin. You should have VFC vaccine codes with the amount of $0.01 set up in your system. These codes are submitted to any Medicaid insurances that provide you with vaccines. Most system will not allow you to submit a zero charge. No modifier is needed. If you need help setting up-private email me.
 
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