modifier for 96372

LDEPASS

New
Messages
5
Best answers
0
Can someone please let me know if there is a new modifier that we must use when billing 96372 and a vaccine when the patient brings in the vaccine, we were told by tricare that we must use a modifier on the jcode showing the patient brought in the vaccine
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
Best answers
0
Can someone please let me know if there is a new modifier that we must use when billing 96372 and a vaccine when the patient brings in the vaccine, we were told by tricare that we must use a modifier on the jcode showing the patient brought in the vaccine
You don't bill 96372 for vaccine or toxoid admins. Only for therapeutic/prophylactic drug admins. If the patient brings in their own vaccine/toxoid product, I'm assuming they're over 18 (or if they're under 18, and no counseling is provided), so you would use 90471. If they're under 18 and counseling is provided, use 90460 for single vaccines, and add a 90461 for each additional component of a combination vaccine. You don't add a modifier, and you don't bill for the product. Hope that helps! ;)
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
Best answers
0
*Clarification

Tricare won't cover a vaccine admin without a product billed. There's no modifier for it.

If they brought in a drug described by a J-code, the same principle applies, except you DO use 96372. Chances are, it 's not going to pay. You don't bill the J-Code, because you didn't provide it to the patient, if they brought it in themselves.
 

jennruss

New
Messages
2
Best answers
0
96372

I am billing commercial, and have had a lot of providers say a mod is needed when billing this with an office visit now. Is there a new edit?
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
Best answers
0
I am billing commercial, and have had a lot of providers say a mod is needed when billing this with an office visit now. Is there a new edit?
You have to have a 25 modifier on the office visit - that's been required for as long as I've been in the business, which is almost 4 years. The admin shouldn't requie one, though. Hope that helps! ;)
 

LDEPASS

New
Messages
5
Best answers
0
thank you, it does, i did mean 90460-1 it was a vaccine, shingles, and tricare is trying to tell us there is a modifier that indicates that the patient brought in the vaccine, they are driving me crazy, but thank you, i was quite sure we only had to bill the admin code, and just omit the j code.......
 

btadlock1

Guest
Messages
1,504
Location
Lubbock, TX
Best answers
0
thank you, it does, i did mean 90460-1 it was a vaccine, shingles, and tricare is trying to tell us there is a modifier that indicates that the patient brought in the vaccine, they are driving me crazy, but thank you, i was quite sure we only had to bill the admin code, and just omit the j code.......
If there is one, it's a HCPCS modifier, and I don't happen to have that book with me. Check there, though. It'll be pretty specific.:)
 

cmercado0526

Contributor
Messages
18
Location
Lebanon, NH
Best answers
0
Correct code, they want more info?

If I'm billing only the injection 96372 with the J-code because the patient brought his own serum (B12), where do I indicate if the injection was SC or IM? I've never had an insurance company need to know this before. The 96372 code indicates it's either SC or IM, but they want to know the 'method of injection'...........?
 
Top