Wiki Denials on 90471 from Medicare Advantage plans

[LPou1003]

Good afternoon everyone,


Has anyone, working as a FQHC, received any denials from Medicare Advantage plans for immune administration code 90471??

We have 28 denials where they state the procedure code is invalid.

There are 2 different scenarios where we got denied.

1. Patient came in to get a TD injection.
We received payment for the medication itself, but not the administration.

2. Patient came in for Hep A & B immune
We got denied the entire claim. The administration because of the invalid procedure code and the Hep A & B because it is a non covered benefit.


I have researched for information on the CMS website and was unable to find anything giving me the reason for the denials.

Were there any changes to this CPT code?

Does anyone have any input on how to proceed with this, or point me in the right direction to find the answer ??

Thank you for your help,

Leslie

 

[AKA whoknows]

Some MA plans want you to bill the G administration code like Medicare it depends on the plan. Also don't know if this helps

per the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-02, Chapter 13, Section 10: 'Payment for Medicare-covered Part B drugs that are not usually self-administered and are furnished by an Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) practitioner to a Medicare patient are included in the RHC and FQHC all-inclusive rate. When I did FQHC billing we had to split bill to part B for the administration codes.

 

[ljjulian]

Can you tell me what codes you used?

 

[AKA whoknows]

codes

Can you tell me what codes you used?

GOOO9,G0008,G0010. I would try contacting your provider rep with those plans for help with this. If you need more information send me a PM.