Wiki Vaccine codes and Modifier 59

[SSMcElyea-Vironet]

Hello everyone! In need of help ASAP!

99214 - Est. Level 4
90746 - Hep B
90471 - Admin >8 yrs old
90632 - Hep A
90472-59 - Add-on

Anthem paid the office visit but not the vaccines and admins. This is how it was originally billed. Now if I'm not mistakened, the add-on code 90472 doesn't need a modifier does it?

I need clarification! Thanks!

Sarah Mc.

 

[mitchellde]

that is correct the first 90472 does not need any modifier.

 

[hpatzke]

that is correct, 90472 does not warrent the use of any modifiers as it cannot be billed without a primary procedure being billed. The primary procedure for 90472 can be billed with any initial immunization cpt code.

 

[poxleitner]

All of the payers I've ever billed to do not require any modifiers on the vaccines but do require a mod -25 on the e/m visit.

 

[kat_232]

I agree with regards to the addition of -25 and no -59 needed.