Wiki Modifier SL

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halebill

halebill

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Does anyone use Modifier SL, State supplied Vaccine? If administering a state supplied vaccine, the state has already paid for it, so you don't bill for it. Should this SL be appended to the administration code? Perhaps it would motivate Medicaid to pay the multiple admin. fees?
 
SL Modifier

In New Hampshire, Blue Cross requires us to use it on the actual vaccine. Also, NH Medicaid has a a certain allowable for the administration of the vaccine. We do put a zero charge on the vaccine. Hope this helps.
 
We bill for the vaccine with the SL modifier and a zero charge also. Then the Medicaid plans know what's being given. We don't put it on the administration.
 
In CA. we bill the CPT vaccine code add modifier SL and bill it at $9.00. Thats what we get paid for each vaccine for admin.This is for our VFC for Medi-cal.
 
So, is anyone willing to help clarify this for me? :)

There are two explanations re: billing SL. One says they bill it with $0.00 and the other says $9.00.

I have 2 questions:

Do we bill it as $0.00 or $9.00?

Is this Medi-Cal/Medicaid only or do all the insurances require an -SL modifier if the vaccine was state supplied, such as VFC?

I just read about it on a UHC website and wonder if it's across all the commercial insurances?

Thanks in advance!!
 
Go to the source

Hi Heidi,

There are so many variations on this process within each state and also each insurance carrier. It can get pretty confusing.
My suggestion is to start with the CDC site :

http://www.cdc.gov/vaccines/programs/vfc/default.htm

You should also look at your state's DOH website and it should also have specifics, BUT- then you will have to dig even deeper and look at your carrier's policies....unfortunately they all make up their own rules as far as how they will pay (i.e.- some will pay under the Admin fee and others will pay only under the vaccine fee).

I would only append the SL modifier to the vaccine CPT code as this modifier means "State Supplied" and an administration cannot actually be 'State supplied'.

I hope this has helped a little.
Good luck!
 
The problem is that I'm the coder, not the biller. I am not even in that dept! Strange, but I had to be moved under another supervisor. So I'm caught in a weird place to not know anything or have any access to carrier differences. I am lucky if I EVER see a denial. The billers work on those and rarely get my feedback.

So, I'm trying to figure out my end without their help :(

That's where you guys come in :)

I have only been putting the -SL on the vaccine, but like a PP said, I still charge for the $9.00 vaccine administration through the use of the vaccine code + modifier. Medi-Cal is weird too and that's how they want it.

What I'm unsure of, is the commercial insurance. I'll put it on there and ask one of the billers for feedback.
 
Since I posted this question, I experimented and found that my state Medicaid and commercial carriers (in SC), do not want any $0 charges or vaccines billed with modifier SL. They only want the administration charges. As apmc said, this is just one of those things that varies from state to state, carrier to carrier.


Bill Hale, CPC
 
IMMS SL Mod -- Wa St -- Under 18

I work as a coder in a Rural Hospital ....

We do use the Mod SL and Charge the Fee that is Charged to us by the State for the Vac (its a reduced price) ... But not to the Patient/Insurance but to simply track costs .. As i understand it .. I'm not a Biller either ...

The Administration do not get a SL mod ... Those are charged to the Insurance ( i think )
 
modefier SL and Sk

Please advise. I am billing 90620 with modifier SL and it is being denied stating **Procedure code billed requires mod. SK***this is not a high risk pt. How do I get this vaccine paid.
 
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