Wiki Billing vaccines for a fqhc

[jeaner54175@yahoo.com]

Our clinic is a FQHC and I'm trying to find out how other clinics bill Medicare for influenza and pneumoccal vaccines. If a patient is seen for an office visit the provider will code a routine office visit (i.e. 99213) along with the codes for the vaccine and its administration code (90670, G0009). Our software automatically adds the HCPCs office code of Go467. Medicare has been denying the vaccine and administrative codes with this denial: C0246 non payable code for reporting only. I've been calling Medicare and the other insurance carriers but I don't get an answer as to why it is denied and I researced on the internet and CMS as well and I can't find a definative answer to what we're doing wrong or how to correct it. Are these codes bundled into the G0467 or do we need to append modifers. Any input would be appreciated.

Thank you,
Lisa

 

[krlsll]

Fqhc

All codes are now bundled into the G0467 and G0466. Some vaccines are still reimbursed in the cost report.

 

[arrana]

We add condition code A6 to box 24 on the UB. Medicare will reimburse flu and pneumococcal on the cost report.

Check out Medicare billing guidelines, chapter 13 for FQHCs.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf

Arrana Ashton, CPC, CEMC

 

[khristinelouise]

We do it the same way you do but we add the condition code A6.

 

[j_oania@yahoo.com]

Same vaccine billing rules for Medicare Advantage plans?

As an FQHC, would we be reimbursed through the cost report for flu/pneumococcal vaccines administered to Medicare Advantage patients as well?