Wiki GA Medicaid Denials for Qualifying Service

[KHerron]

I have been seeing several claims when GA Medicaid is primary payer. For example, one claim is for a patient who is 21 years of age. We billed a 99213,25 with E11.69 and Z79.899 / 90471 with Z23 / 90673 with Z23 / 90480,59 with Z23 / 90673 with Z23. All lines have denied. From my past experience with Medicaid (which has been years ago so a lot could have changed), they should be paying for at least the office visit and vaccines. According to their portal the 90673 is on their fee schedule. I do not see the Covid vaccine listed though. Has anyone else see this who can help me out? Any guidance would be greatly appreciated!!

 

[thranowski]

What was the denial reason?

 

[TThivierge]

I have been seeing several claims when GA Medicaid is primary payer. For example, one claim is for a patient who is 21 years of age. We billed a 99213,25 with E11.69 and Z79.899 / 90471 with Z23 / 90673 with Z23 / 90480,59 with Z23 / 90673 with Z23. All lines have denied. From my past experience with Medicaid (which has been years ago so a lot could have changed), they should be paying for at least the office visit and vaccines. According to their portal the 90673 is on their fee schedule. I do not see the Covid vaccine listed though. Has anyone else see this who can help me out? Any guidance would be greatly appreciated!!

KHerron
If pt has dx E11.69 why use Z79.899 why not use Z79.8 or Z79.4 per documentation? On Z code defines insulin injection other DM pills as meds. Remove modifier 59 not necessary since pt. got 2 vaccines.I hope this data helps you
Lady T