OnelM2023
Networker
hello everyone. A little help here if possible. I truly dont understand what I am doing wrong that I dont get paid for the extra components of the vaccines....See below
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Wiki FLORIDA MEDICAID VACCINE CODING
- Thread starter OnelM2023
- Start date
rthomas@impcna.com
Guru
I know all states are different but in Mississippi Medicaid doesn't reimburse additional components (90461) We send it with a 0.00 charge.
OnelM2023
Networker
Appreciate your response, But I thought Florida Medicaid paid for the additional components. Is anyone from Florida that can help me with this..
rthomas@impcna.com
Guru
Have you tried billing as units instead of individually? For example:
90696
90707
90716
90460 x 3
90461 x5
OnelM2023
Networker
Yes, the 90461 comes back denied, it should pay the additional components
OnelM2023
Networker
so no one from Florida that can answer this? Medicaid is so tricky....
OnelM2023
Networker
kdlberg
Guru
Sorry, I am not on the forums consistently.
Florida Medicaid will not pay for additional components.
"As part of the Patient Protection and Affordable Care Act (PPACA) regulations the Centers for Medicare & Medicaid Services (CMS) require Medicaid programs to reimburse for VFC services on administration codes 90460, 90471, 90472, 90473, and/or 90474 rather than the serum/toxoid code. Per the PPACA legislation, CPT code 90461 is NOT reimbursable."
Florida Medicaid will not pay for additional components.
"As part of the Patient Protection and Affordable Care Act (PPACA) regulations the Centers for Medicare & Medicaid Services (CMS) require Medicaid programs to reimburse for VFC services on administration codes 90460, 90471, 90472, 90473, and/or 90474 rather than the serum/toxoid code. Per the PPACA legislation, CPT code 90461 is NOT reimbursable."
OnelM2023
Networker
Hello,
Thank you for the response, but I have also billed under 90471 and 90472 for the additional components. So, they just pay for a limit of 4 in total for a claim? for example:
90700, 90648, 90671
So what you are saying it should be billed like this:
90460X3
90700
90460x1
90648
90460x1
90671
or
90460x1
90700
90460x1
90648
90460x1
90671
90472x1
90472x1
Thank you for the response, but I have also billed under 90471 and 90472 for the additional components. So, they just pay for a limit of 4 in total for a claim? for example:
90700, 90648, 90671
So what you are saying it should be billed like this:
90460X3
90700
90460x1
90648
90460x1
90671
or
90460x1
90700
90460x1
90648
90460x1
90671
90472x1
90472x1