I'm having some trouble getting vaccination administration codes paid for adults... We're billing G0008 (admin of flu vaccine), 90471-polio, 90472-Tetanus & diptheria. I believed CMS recognized the G code as an initial code so originally we billed the G code and only 90472s for the remaider of the drugs. We changed that and now we are billing as stated above. We are getting denials now because the 90471 and the G code are bundled. I chaecked CCI and they are bundled. WPS (our carrier) is telling us we need a 59 on the G code... I was under the impression that we don't use modifiers on HCPCS codes?? Anybody had any luck getting these code sets paid when having to bill with the G code for either flu or pneumoccoccal vaccines? Thank you!!
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Wiki Vaccinations--Please help!!
- Thread starter kmasters
- Start date
Lisa Bledsoe
True Blue
Are you billing 90471 and 90472 with E/M's? They are not billable on the same day as an E/M.
No E&M... Here's the way it looks, for example...
G0009
90732
90472
90718
90472
90713
90472
90648
I've tried billing a 90471 with a G0009, but that didn't work; that's when the bundling denial came about. The 90472 will not pay w/o billing a 90471. The 90471 will not pay w/ the G0009... I have also tried billing the 90472s in units, but that didn't work either. Thanks!
G0009
90732
90472
90718
90472
90713
90472
90648
I've tried billing a 90471 with a G0009, but that didn't work; that's when the bundling denial came about. The 90472 will not pay w/o billing a 90471. The 90471 will not pay w/ the G0009... I have also tried billing the 90472s in units, but that didn't work either. Thanks!
Lisa Bledsoe
True Blue
90718, 90713 and 90648 are not covered by Medicare, so the administration codes would also not be covered.
halebill
Guest
Be sure to have your patients sign an ABN before receiving these non-covered items, and bill them to Medicare with modifier GA appended. Then you will be able to bill the patient.
Lisa Bledsoe
True Blue
In that case, I would contact your MAC/FI and see what the problem is. Sometimes they can be very helpful... Good luck!
strwberry239
Guest
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I am also having issues with Medicare denying the Admin G codes with 90472's =. regardless of the Medication. The fact is that they are bundling the G codes with the additional Vaccination admins.
LTibbetts
Guest
Hi Lisa, Can't you bill both with a -25 on the E/M. We have been doing that in our ER visits for some time now. Is this not correct? We are also critical access if that matters. Thanks
Lisa Bledsoe
True Blue
Leslie - could be different for critical access. I know in the office setting Medicare will not pay 90471-90472 even when a covered vaccine is given at the time of an E/M. The exception is G0008 and G0009.