Wiki VACCINE BILLING FOR VFC (state supplied) PATIENTS

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tlm5506

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Hello.
Big debate in our office now about the correct way to bill for vaccines for patients receiving Dtap or other vaccines with multiple components. We are located in Michigan, and Medicaid and other low income or no insurance patients receive the vaccines free and we are only allowed to charge $23.03 for the administration. For a patient receiving a Dtap vaccine, we are using 90460 which would be for the 1st component of the vaccine, and then we are billing 90461 for the 2nd and 3rd component of the vaccine. Now we are being told that that is not the correct way to bill - that we should be using just the 90460, even if the vaccine has more than 1 component. Also, if a patient is receiving more than one vaccine, such as Dtap, PCV 13, Hep B, etc., I am wondering if 90460 should be listed 3 times or if the units should be changed to 3. This is really confusing. Any help would be appreciated.
Thanks.
 
In GA when billing Medicaid for VFC vaccines, we use 90460 for the 1st vaccine (when there is a face-to-face w/a qualified healthcare professional), and 90472 for additional vaccines. Using your example of patient (age 18 or younger) receiving Dtap, PCV 13 and Hep B (w/a face-to-face), we would bill 1 unit of 90460 and 2 units of 90472. If no face-to-face and/or patient over 18, we would bill 1 unit of 90471 and 2 units of 90472.

It's only when billing commercial insurance that you can bill for each component of a vaccine. Hope this helps.
 
VFC For State-Mandated Programs

In New York, Medicaid requires us to bill per vaccine administered with 90460 (regardless of counseled or not), not per component. We bill 90460 for each vaccine, 1 unit each line. And we're reimbursed $17.85 per admin. When we attempted to bill multiple units with multiple diagnoses, our claims have only paid on the 1st unit. And now that NYS MA only allows 30 days to appeal a claim it's nearly impossible to do so.

I found this link online for MDCH Vaccines For Children. Hope this helps:

http://www.michigan.gov/mdch/0,4612,7-132-2942_4911_4914_47701-169020--,00.html

Just like sbgill states, we also only bill the additional components to commercial plans.

Good luck :)
 
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