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Coding Medicaid VFC Vaccines/Administrations in Florida

  1. #1
    Default Coding Medicaid VFC Vaccines/Administrations in Florida
    Medical Coding Books
    Hello,

    I am somewhat new to Pediatrics billing. Before I started working here my office used to bill an administrative code for Well shots, but medicaid always denied them so they stopped billing for it. Medicaid does pay us $10 for each drug however.

    Could someone please tell me what codes we should be using to get both the admin and the drug paid? We were recently told that both would pay if we billed it correctly, but of course they would not give us the correct codes.

    Thank you in advance for any help.
    Tracy S, CPC, CASCC

  2. #2
    Default What we do here in NY.....
    Hi Tracy,

    With the Vaccines for Children program, Medicaid states since the vaccine is no charge to the practice, they will reimburse up to $17.85 for the administration, storage and such. Since there are numerous Medicaid HMO's that pay differently we bill both the Administration code (90471,90472, 90465,90466,90467,90468) and the vaccine code at $18.00 each. We know we will only get paid for one of the two.....
    Straight Medicaid will usually pay the vaccine and zero to the admin. Half of the HMOs will pay only the admin and zero for the vaccine.
    Either way we only get up to $17.85 per vaccine given.
    Of course, don't forget the SL modifier on each vaccine code!

    Hope that helps you.

    Susan

  3. #3
    Default
    Thank you for your response. I just couldn't find anything showing where both could get paid.

    I appreciate your help.
    Tracy S, CPC, CASCC

  4. #4
    Default ?????
    What is the sl modifier for?

  5. #5
    Default SL modifier
    SL modifier identifies the vaccine as a state supplied vaccine.

  6. #6
    Default
    Hi,
    where do you use SL modifier? For vaccine or for administration? and is it different for different insurance companies.
    Thank you,
    Anu.

  7. #7
    Smile
    Quote Originally Posted by TracyS View Post
    Hello,

    I am somewhat new to Pediatrics billing. Before I started working here my office used to bill an administrative code for Well shots, but medicaid always denied them so they stopped billing for it. Medicaid does pay us $10 for each drug however.

    Could someone please tell me what codes we should be using to get both the admin and the drug paid? We were recently told that both would pay if we billed it correctly, but of course they would not give us the correct codes.

    Thank you in advance for any help.

    First, what state are you in?

    This info that I am given is the State of Maryland
    Example claim---coding/billing for a wv for age 5 w/ 3 vaccines and admin...

    DX-V20.2, V04.89, V06.1, V05.3

    99393-25
    90649
    90715
    90633
    90465x1 or 90471x1
    90466x2 or 90472x2

    Please note that State of MD pays for the wv, drug and nothing for the admin...This was not so several years ago (went into effective last year); They used to pay the admin and not the drug (VFC)... So really it depends on your State. You will need to call your Provider Relations Rep and get a copy of your contract.

    Hope this info has help you....
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  8. Default
    Florida Medicaid does not pay for administration for immunizations with the exception of the H1N1 (90470).

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