Humana denying vaccines

[klester2018]

I work for a family practice and I am having Humana denials on vaccines for reason:

This decision was based on a Local Coverage Determination (LCD). We have called them several times and sent in documentation from there website stating they cover these vaccines and from the Medicare website. Does anyone have any solutions to this problem?​

 

[mwinkwalk11@gmail.com]

What specific vaccines are being denied? Are you asking about a Medicare Humana policy or commercial Humana? Is it possible the patient has had the vaccine before?

 

[klester2018]

What specific vaccines are being denied? Are you asking about a Medicare Humana policy or commercial Humana? Is it possible the patient has had the vaccine before?

The flu and pneumococcal, Humana Medicare, I don't think so because it denies on all claims with E/M visit even though I am adding modifier 25 to the visit.

 

[SharonCollachi]

Have you checked the Medicare web page to see when the patient is eligible for that vaccine?

 

[Herbie Lorona]

What CPT codes and DX codes are you billing with?