My practice ran out of flu vaccine, and the only available vaccine in our area was the Fluvalal, quadrivalent w/ preservatives vaccine. We ordered 100 doses and began billing for it. I checked w/ GSK and the correct CPT code for this is 90688 since it is WITH preservatives as opposed to without, which is 90686.
Unfortunately, Medicare is denying it for medical necessity. They list a payment for it on their website, but apparently this doesn't mean they will pay it. The code did have a lightning bolt for FDA approval pending in the book, but it was approved in August of this year.
So we are now having to appeal and prove medical necessity for all the Medicare doses we gave out.
Has anyone else had to deal with this issue? Any helpful tips?
Thanks!
Unfortunately, Medicare is denying it for medical necessity. They list a payment for it on their website, but apparently this doesn't mean they will pay it. The code did have a lightning bolt for FDA approval pending in the book, but it was approved in August of this year.
So we are now having to appeal and prove medical necessity for all the Medicare doses we gave out.
Has anyone else had to deal with this issue? Any helpful tips?
Thanks!
