Vaccine for children

[alessandra]

Can somebody help me with the State supplied vaccine for children Modifier. I`ve been using the Mod SS for more than a year, all of the sudden mostly of the NJHEALTH claims have been denied for wrong Modifier. Can also somebody give an example on how to post a well visit with vaccines

 

[mcpalmeter]

Not sure where the SS modifier came from as per the HCPCS Level II manual SS modifier means home infusion services provided in the infusion suite of the IV therapy provider. I guess it depends on your Medicaid carrier. FL Medicaid reimburses an administration fee to physicians, ARNPs and PAs providing free vaccines through the VFC Program to Medicaid-eligible recipients from birth through 18 years of age. Providers are instructed to bill the CPT code specific to the vaccine administered and not the administration code. Per p. 3-22 of the Provider Handbook for Horizon NJ Health, The Vaccines for Children Program (VFC) provides all standard immunizations for individuals under age 19 with NJ FamilyCare Plan A coverage; therefore, your office will not be reimbursed for these drugs if the member has NJ FamilyCare Plan A coverage, but will be paid an administration fee. The specific CPT-4 code for the vaccine(s) given must be entered on the claim form.

Are you billing the vaccine code or the admin code?

 

[alessandra]

I can give you an example. A patient came to the office for a WV with vaccines. That`s how I code it
99392,25 Z00.129
90744,SS or SL Z23
90472

90680,SS or SL Z23
90473
We just charge the WV and the admin code