Wiki immunizations and modifiers

[rogerandpaula@mchsi.com]

I am confusing myself now I think with the modifiers. Here is the situation.

90734 - Z23
90460 - Z23
90715 - Z23
90461 - Z23
90686 - Z23
90461 - Z23

Do I need a modifier on the second 90461??

Please and thank you!

 

[Samantha.Prince]

90461 x units

I would suggest billing 90461 x 2 (or however units are being billed). The insurance carrier should have guidance on how they would like this code billed if it deviates from that. It's an add-on code so it's expected that the provider may be billing multiple units because 90461 is for each additional vaccine.

 

[kfelix@dvohmg.com]

No modifier.. Just change number of units. Is how I would do it. Let me know

 

[sluke9]

This is how we bill it:
If it is a commercial insurance: 90734, 90715, 90686, 90460 with 3 units and then the component code 90461 with 2 units.

Medicaid plans don't want the 90461 billed so you would leave that off. In Ohio we can't even put it on the claim but I would double check with your state plan.