Question Tricare not paying the admin for state supplied vaccines?


Tucson, AZ
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hello fellow coders.

I have just started a new job working denials in a new market (to me) and am coming across situations that are new for me.

I am finding that Tricare will not pay for the administration of vaccines (90471, 90472, 90460, 90461), when the vaccine itself is supplied by the state. these are being billed with the vaccine CPT and an SL modifier, but they are saying that you cannot bill the administration without, also, billing the vaccine (which is included on the claim).

I am just trying to understand what's happening and am wondering if there is anything that can be done to get the admin paid (correctly).

thanks in advance for any insight into this situation.
- Lisa
Is there a reason why Tricare patients are being given state supplied vaccines?

In NY the state supplied vaccines (VFC program) can only be given to patients who are uninsured or are underinsured. Which would make sense as to why Tricare is not reimbursing for the admin fee.

If your Tricare patients are fully insured they should be receiving vaccines that were paid for by the office that is administering the vaccine.
thank you, both, for your responses.

I am not sure why our clinics are using state supplied vaccines, but they are not covid vaccines.
I have seen this for meningitis and tDap vaccines.

I will ask about this, but I was wondering if there was a known issue with Tricare not paying for the administration.
I assume you are talking about the Covid vaccines. You use specific administration codes depending on which vaccine and dose was given. Attached is a list of shots and their corresponding admins that you need to bill with.
Hi Krisw7067. We have been been children the Covid 19 vaccinations ever since the CDC recommended that they get them. Most of our payers have been paying for the administration code until recently, Tricare started recouping the administration fee for the Covid 19 vaccinations stating it was a system error. Have you or anyone else experience this issue. One of our payers have been applying the administration fee to their member's deductible.