Denials on 90471 from Medicare Advantage plans

LPou1003

Contributor
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Rio Rico, AZ
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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? :confused:

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

Thank you for your help,

Leslie
 

AKA whoknows

Networker
Local Chapter Officer
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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.
 
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