Wiki VACCINES FOR CHILDREN and ADMINISTRATION CODES

[baskiles]

Hello, needing direction on whether or not you submit the vaccine on your claim to MCO's (TN specifically) with administration code and SL modifier, or is the SL modifier added to the vaccine code as well or do you just submit the admin code with SL modifier on the claim and leave the vaccine off the claim? Where do you find support for how you might do this? Any direction/suggestions are greatly appreciated. We have this discussion in our office every other month and each MCO adjudicates these claims differently.

 

[midnight1995]

The State of TN has 3 Medicaid MCO plans: If this is for ESPDT/VFC billing each Insurance has the billing guidelines as well as Medicaid of TN.
1.) Medicaid/TennCare
a.) VFC billing: https://www.tn.gov/health/cedep/immunization-program/ip/vfc/vfc-provider-guidance.html
b.) Vaccines CPT bill with $0.00 bill fee
2.) Amerigroup https://provider.amerigroup.com/tennessee-provider/claims/reimbursement-policies
a.) Under Prevention: EPSDT and VFC guidelines
b.) per the guidelines VFC follows Medicaid guidelines.
3.) BlueCare TN: https://bluecare.bcbst.com/providers/tools-resources/general/tenncare-kids-toolkit
a.) They also follow Medicaid
4.) United healthcare Community plan of TN https://www.uhcprovider.com/content.../UHCCP-Vaccines-for-Children-Policy-R7109.pdf

 

[baskiles]

Thank you so much for your response. I really appreciate it and have bookmarked the links.