Wiki Coding Medicaid VFC Vaccines/Administrations in Florida

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TracyS

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Hello,

I am somewhat new to Pediatrics billing. Before I started working here my office used to bill an administrative code for Well shots, but medicaid always denied them so they stopped billing for it. Medicaid does pay us $10 for each drug however.

Could someone please tell me what codes we should be using to get both the admin and the drug paid? We were recently told that both would pay if we billed it correctly, but of course they would not give us the correct codes.

Thank you in advance for any help.
 
What we do here in NY.....

Hi Tracy,

With the Vaccines for Children program, Medicaid states since the vaccine is no charge to the practice, they will reimburse up to $17.85 for the administration, storage and such. Since there are numerous Medicaid HMO's that pay differently we bill both the Administration code (90471,90472, 90465,90466,90467,90468) and the vaccine code at $18.00 each. We know we will only get paid for one of the two.....
Straight Medicaid will usually pay the vaccine and zero to the admin. Half of the HMOs will pay only the admin and zero for the vaccine.
Either way we only get up to $17.85 per vaccine given.
Of course, don't forget the SL modifier on each vaccine code!;)

Hope that helps you.

Susan:D
 
SL modifier

SL modifier identifies the vaccine as a state supplied vaccine.
 
TracyS said:
Hello,

I am somewhat new to Pediatrics billing. Before I started working here my office used to bill an administrative code for Well shots, but medicaid always denied them so they stopped billing for it. Medicaid does pay us $10 for each drug however.

Could someone please tell me what codes we should be using to get both the admin and the drug paid? We were recently told that both would pay if we billed it correctly, but of course they would not give us the correct codes.

Thank you in advance for any help.
Click to expand...


First, what state are you in?

This info that I am given is the State of Maryland
Example claim---coding/billing for a wv for age 5 w/ 3 vaccines and admin...

DX-V20.2, V04.89, V06.1, V05.3

99393-25
90649
90715
90633
90465x1 or 90471x1
90466x2 or 90472x2

Please note that State of MD pays for the wv, drug and nothing for the admin...This was not so several years ago (went into effective last year); They used to pay the admin and not the drug (VFC)... So really it depends on your State. You will need to call your Provider Relations Rep and get a copy of your contract.

Hope this info has help you....:)
 
Florida Medicaid does not pay for administration for immunizations with the exception of the H1N1 (90470).
 
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