Wiki Covid vaccine CPT code for Medicaid

[jbhuju]

hello ,

recently we are getting denial from Medicaid for covid vaccine cpt (91300-91307) stating need to use different code. i did research but could not find any other cpt than this. please help you know about any other cpt for Medicaid.
thank you .

 

[sls314]

Medicaid coding and billing requirements will vary by state. (Some states like to make it complicated for us & do their own thing!)

It looks like you're in Arizona. I found an Arizona Medicaid website for specifically for COVID-19 coding and billing guidance:

Medical Coding Resources

azahcccs.gov

Are you billing for the administration of the vaccine or the vaccine itself? On the link I posted above, I saw an updated document dated 4/14/22 that has the codes and requirements for COVID-19 vaccine administration:
https://azahcccs.gov/PlansProviders...D19VaccineAdministrationBillingGuidelines.pdf

Hopefully some of those links help you find what you need for your state.

 

[jbhuju]

Medicaid coding and billing requirements will vary by state. (Some states like to make it complicated for us & do their own thing!)

It looks like you're in Arizona. I found an Arizona Medicaid website for specifically for COVID-19 coding and billing guidance:

Medical Coding Resources

azahcccs.gov

Are you billing for the administration of the vaccine or the vaccine itself? On the link I posted above, I saw an updated document dated 4/14/22 that has the codes and requirements for COVID-19 vaccine administration:
https://azahcccs.gov/PlansProviders...D19VaccineAdministrationBillingGuidelines.pdf

Hopefully some of those links help you find what you need for your state.

thank you so much for all the info. yes we did same as the guideline but still they denied may be they want us to work more i am not sure what kind of another code they are looking for .

 

[sls314]

thank you so much for all the info. yes we did same as the guideline but still they denied may be they want us to work more i am not sure what kind of another code they are looking for .

Just to clarify...did you bill the 91300-91307 codes? Or did you bill the administration codes on page 3 of the PDF that I linked?

From the document, it looks like they want the administration codes. Ex - According to the PDF, 0051A is the code they for administration of the first dose of Pfizer for DOS 1/3/22 and after, and the reimbursement rate is $83.

 

[jbhuju]

Just to clarify...did you bill the 91300-91307 codes? Or did you bill the administration codes on page 3 of the PDF that I linked?

From the document, it looks like they want the administration codes. Ex - According to the PDF, 0051A is the code they for administration of the first dose of Pfizer for DOS 1/3/22 and after, and the reimbursement rate is $83.

yes we bill both admin code and 91300-91307 same like the one from the link that you have attached.