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FLORIDA MEDICAID BILLING

O

OnelM2023

Networker
Messages
47
Location
Cape Coral, FL
1791662238448.png
Hello everyone,

I’m having a bit of an issue billing Florida Medicaid for vaccines. I have also billed using the SL modifier, but I’m still receiving the same denials.

From my understanding, Florida Medicaid does not pay separately for the vaccine components and only reimburses for 90460 or 90471.

Any help or guidance with this would be greatly appreciated. Thank you!

16 - Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
M51 - Missing/incomplete/invalid procedure code(s).
N111 - No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
M51 - Missing/incomplete/invalid procedure code(s).
 
OnelM2023 said:
View attachment 9258
Hello everyone,

I’m having a bit of an issue billing Florida Medicaid for vaccines. I have also billed using the SL modifier, but I’m still receiving the same denials.

From my understanding, Florida Medicaid does not pay separately for the vaccine components and only reimburses for 90460 or 90471.

Any help or guidance with this would be greatly appreciated. Thank you!

16 - Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
M51 - Missing/incomplete/invalid procedure code(s).
N111 - No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
M51 - Missing/incomplete/invalid procedure code(s).
Click to expand...
I am not in Florida but we had this issue with Mississippi at one time. Using the vaccines only from your example, this is how we would have to charge them.

CPT Quantity Price
90680 1 0.00
90697 1 0.00
90677 1 0.00
90460 3 75.00
90461 5 0.00

We would have to use the 90461 for additional components if there are multiple and of course we would use the appropriate modifiers as well.
 
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