Wiki Z23 Denials and Medicare

[isabel68l]

Hello, I'm hoping ya'll can give me some information on Medicare patients who have a visit only for Immunizations. We are using Z23 only and Medicare does not like any z codes as primary DX.
Is this an encounter for a ABN ?.. Is there another payable Dx for these?.. Any info will help... Thank you

 

[sls314]

Hello, I'm hoping ya'll can give me some information on Medicare patients who have a visit only for Immunizations. We are using Z23 only and Medicare does not like any z codes as primary DX.
Is this an encounter for a ABN ?.. Is there another payable Dx for these?.. Any info will help... Thank you

The Medicare website says to use Z23 for covered immunizations: https://www.cms.gov/Medicare/Preven...ervices/MPS-QuickReferenceChart-1.html#PNEUMO

Which immunizations are you billing? Are they not on the covered list?

 

[trarut]

As Susan says, check the coverage. That could very well be the root of the problem. Medicare only covers a few vaccines under Part B, others are only available through Part D. There's this resource as well, looks like the last update was in 2023: https://www.cms.gov/outreach-and-ed...loads/vaccines-part-d-factsheet-icn908764.pdf.

 

[isabel68l]

Thank you, Kindly. This helps me.