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Zostavax Administration

TERESAL

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1
Location
Ravenna, OH
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What code are you using for the administration of Zostavax. This is the problem I am encountering:

Medicare is not supposed to pay for the vaccine or the administration. Ususally you must bill Medicare 1st, receive the denial and then send to the secondary for the secondary to pay.

Because there is not definitive code for the diagnosis, only generic V05.8, and you bill 90471, they will pay because that diagnosis code is an unspecified code and Medicare would never know you gave the Zostavax vaccine. There used to be a G code for part D administration of this vaccine, but either it is deleted now or I can not find.

Help! What code to use for administration, CPT and DX?
 

codelady

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28
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Zostavax

We use the 90736 and 90471 for the admin of shot (if it's medicare use G0008)
 

pamtienter

Expert
NAB Member
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349
Location
Mound, MN
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We use G0377 (Administration of vaccine for Part D drug) with diagnosis code
V04.89 (need for prophylactic vaccination and inoculation against certain viral diseases–other).
 

Lisa Bledsoe

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2,046
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Greeley, Colorado
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We use G0377 (Administration of vaccine for Part D drug) with diagnosis code
V04.89 (need for prophylactic vaccination and inoculation against certain viral diseases–other).
Pam - when you use G0377 how does Medicare deny it? Are they denying as patient resonsibility or contractual obligation?
 

pamtienter

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Mound, MN
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It looks like we bill G0377 and 90736 but they both actually get billed to the patient to submit to Part D. They can then turn over the payments to us. Since we don't necessarily get a copy of any EOB, I'm not sure what Part D pays on the administration, if anything. Sorry I don't know more than that.
 

pamtienter

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NAB Member
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349
Location
Mound, MN
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I was following a patient's account that I had gotten questions on and they have posted her Medicare payment that she forwarded to us so they must pay without that denial. We have an internal policy that I was given where they inform the patient up front that they will be given the paperwork (bill) and they will be responsible for sending it to their Part D and then paying us. Seems to be working fine.
 

Herbie Lorona

Expert
Messages
409
Location
Yuma
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We use the NaviNet website to get Zostavaz paid by Medicare. It tells you if the patient has the coverage, how much they will pay and how much the patient needs to pay. It is pretty nice even though i havent got to use it since we set it up
 

DeeCPCPNH

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Zostavax

What code(s) should be used for the Medicare patient who is covered uner a Managed Medicare Plan? Do you still code 90736 and 90471 or (Gcode)? Or do you bill the patient directly for both services? Or :confused:are the carriers eligible to be billed?
 

DeeCPCPNH

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Thank you all for posting

G0377 is not in the 2010 HCPCs so I will go with the G0008 code only. We order and the patientpicks it up so the only code to charge is the administration fee.
 

rose2014

Contributor
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20
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For administring the PART D vaccine ie ZOSTAVAX,should the provider have contract with part d.We are IM and have part B.

May I request some light on this subject.

Thanks
 

Lisa Bledsoe

True Blue
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2,046
Location
Greeley, Colorado
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G0377 is not in the 2010 HCPCs so I will go with the G0008 code only. We order and the patientpicks it up so the only code to charge is the administration fee.
G0377 has been deleted, but using G0008 would not be appropriate as that is for influenza vaccine administration.

So if we bill 90471 with 90736 how does Medicare know not to pay? Should an ABN be obtained and GZ and/or GY applied or is the ABN necessary?
 

tonirae

New
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3
Location
Star, ID
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Toni, CPC

We are just starting to offer the Zostavax here in our clinic. Our first patient is Medicare/Tricare. Anyone out there been paid on this similar situation? I would love to know the reimbursement amount. Thanks for any input.
 

lisa dixon

Guest
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10
Location
Gainesville, GA
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We use E-Dispense. Our drug rep. came along and got us set up with this company. We put in the patient information and the system tells us what the patient is responsible for and the patient must pay his/her portion at time of service. Then we file the claim with E-Dispense on their web site and they send the payments straight to us. This has worked well for us so far. :)
 

Stefanie

Networker
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87
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We are not giving the Zostavax to Medicare patient's in the office. Medicare only covers the Zostavax as a Part D benefit, therefore, if given by a Medicare Part B (doctor's office) provider, the Zostavax will be denied as patient responsibility. We are giving our Medicare patient's a script to be filled and administered at the local pharmacy. You currently don't have to have an ABN signed for the service to be billable to the patient, it is currently never covered by Medicare Part B and does not require an ABN.
 

sallywilkins

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12
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Zostavax administration fee

So, now that the G0377 is not in the HCPCS book, can we safely guess that we are suppose to use 90471?
 
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