Wiki Preventitive Visits and Immunizations

[vhammons]

We are getting denials for the admin fee of a vaccine during a Preventative visit. This is the first year this has happened. Is anyone else getting this, and can we do anything to get it paid?

 

[aaguiar]

Are you seeing this with what payer? I have only seen one payer (Cigna). And are you billing with the 25 modifier on the physical exam CPT code?

 

[vhammons]

It is with Wellmark, and our system tells me not to use the 25 modifier. I will over ride and try it with the modifier. thanks for your help!

 

[Lynda Wetter]

See page 478 & 479 in CPT. You are going to have to append modifier 25 to the E/M.
NCCI edits put an edit on the Administration code & E/M visit as of 2013. From what I have read the AAP American academy of Pediatrics has filed a complaint and suposedly CMS is looking into correcting the edit.

Hope this helps.

Also check your local Medicare carrier if its Medicare.
MD & PA require the AT mod sometimes.