Wiki NDC# denied as invalid for TDAP and Prevnar

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Lynnctodd

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In the past month, our practice (primary care) started getting denials from Medicare and Bcbs for TDAP vaccine (NDC 49281-0400-15) and Prevnar vaccine (NDC 00005-1971-02), stating invalid NDC code. We had not changed anything in our system and have verified the numbers on the vaccine box and it is correct. We have researched online and cannot find that anything has changed. Now, we are starting to receive NDC denials from other insurances-UHC, Aetna, etc. I have called several insurance companies and all they tell us is that it is invalid. Help!
 
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I must confess to being a "new" coder, but happy to pass on what I was told in our practice (Pediatrics). I was told to always use the NDC# from the individual dose (vial or syringe), not the box. The patient did not get a "box" of Tdap, they got one dose.

For example, for Adacel (Sanofi brand Tdap):
49281-0400-88 is the NDC printed on the prefilled syringe ... they come in a box of five with the NDC 49281-0400-15.
Also available are single dose vials (49281-0400-58) that come in a box of 5 (49281-0400-05) or 10 (49281-0400-58).

Following this logic, the NDC you mentioned (49281-0400-15) says you gave the patient all 5 Tdap syringes in the box.

A coworker is fighting with one insurance (not 100% sure, but I think it's Tricare) who is denying our NDC. We guess they are looking for the vial NDC and we buy the prefilled syringes. Other than that, this has worked for us.
 
HangarPilot is correct the NDC being used is for the box and you need the vial specific NDC. Why the payer just noticed it recently who knows



5 SYRINGE in 1 PACKAGE (49281-400-15) > .5 mL in 1 SYRINGE (49281-400-88)
10 SYRINGE in 1 CARTON (0005-1971-02) > .5 mL in 1 SYRINGE (0005-1971-01)
 
BCBS, Tricare, etc...

We are seeing the same issue with BCBS-OK Pediatric's practice. We billed single vial NDC's for Roto, Hib & DTap not using box NDC's and all are being denied for the same reason. We too have changed nothing and when contacting BCBS we are also being informed it's an invalid NDC.
 
Ndc#

I have also experienced the same problem with UHC. I went back and confirmed that I was using the correct NDC#. I contacted UHC and I am being told that there was a system glitch and UHC is going to go back and reimburse for all vaccine denials due to the NDC#. We have not yet been reimbursed for any vaccines that were denied. Has anyone else had the same info from UHC?
Thanks!
 
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