I'm having an issue with Medicaid where they are denying the 90461 immunization administration code but paying on the 90460 code when billed together. I list the correct number of components but do not understand why they deny it. The denial includes 2 codes CO-45 <typical and N381 - see contract agrmt for charge info. Can someone please shed some light?
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Wiki Medicaid billing & immun administration codes
- Thread starter claimsmartsolutions@gmail.com
- Start date
We use these codes, they aren't billable by toxoid like the 90460 and 90461 though.
90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472 - each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90473 - Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
(Do not report 90473 in conjunction with 90471)
90474 - each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
➲CPT Changes: An Insider’s View 2002
➲CPT Assistant Feb 01:5, Nov 02:11, Apr 04:14, Apr 05:1, 3, Jan 09:3, 8, Jul 09:7, Aug 09:9, Oct 09:3, Mar 11:3, Jun 11:14, Jul 12:7, Aug 13:10, Mar 14:10, Apr 15:9, May 15:6, Nov 18:7, Jan 23:1
(Use 90474 in conjunction with 90460, 90471, 90473)
90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472 - each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90473 - Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
(Do not report 90473 in conjunction with 90471)
90474 - each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
➲CPT Changes: An Insider’s View 2002
➲CPT Assistant Feb 01:5, Nov 02:11, Apr 04:14, Apr 05:1, 3, Jan 09:3, 8, Jul 09:7, Aug 09:9, Oct 09:3, Mar 11:3, Jun 11:14, Jul 12:7, Aug 13:10, Mar 14:10, Apr 15:9, May 15:6, Nov 18:7, Jan 23:1
(Use 90474 in conjunction with 90460, 90471, 90473)
rthomas@impcna.com
Guru
Medicaid doesn't reimburse for additional components. 90461 is for any additional components of the vaccine. If the provider is an EPSDT provider and enrolled in the Vaccine For Children program then you can bill for 1 component per vaccine, 90460. When we send claims with vaccines that 90461 is used, we enter the # of units but bill as $0.00 since they do not reimburse. There should be something in the VFC provider manual or the EPSDT provider manual.
Think of it this way, on self pay children when they are given vaccines that are supplied by the state of FL, $24.01 per vaccine administration (90460) is the max you can charge a patient and can't charge them for the additional components.