Wiki Modifier 59 on administration codes for injections.

[Lynnctodd]

I work at a Primary Care office and recently have received multiple denials on BCBS claims with vaccine injections. I contacted BCBS and was told that the administration code 90471 (billed with modifier 59) that we use for flu and pneumonia vaccines has "expired as of November 20, 2017". She said if I bill 90471 WITHOUT the modifier 59 that it is a valid code. I have researched on Google and cannot find any info about the modifier changing or no longer being required on administration codes. Do anyone have any info you can provide? Is this just for BCBS or for all insurances? I also have some Humana denials from vaccine injections and I am wondering if it is the same issue...

 

[kroemer4]

-59 Mod on Immune Admin Codes

The only information I have is regarding Medicare and I am currently attempting to understand in the practice of appending the -59 modifier to immunization administration codes. Per my research, the only valid time a -59 should be added to the CPT admin codes is when Medicare's G-codes are billed along with other immunizations received that day. This doesn't answer your question, but any information you could provide relating to why the modifier is appended for non-Medicare immunizations would help me as well.

 

[crogers@accelhc.org]

I too am having denials from BCBS. We place a modifier 25 on the E/M and then a Modifier 59 on the 90471. These were paying up until now, https://www.bcbstx.com/pdf/modifier_25_and_ 59_faq.pdf this is the only thing I could find. I have also been directed to Clear Claim Connections on the Availity website, which doesn't help as it allows with or without the Modifier 59. We are going to try and bill without the modifier 59 on the 90471.

Please let me know if anyone finds out any different information. I'm thinking that we may start having an issue with J-codes and the administration.