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Thread: Cpt 90736

  1. #1
    Join Date
    Apr 2007
    Location
    Rome, GA
    Posts
    295

    Question Cpt 90736

    Does CPT 90736 (Zoster vaccine) have any age specifications. BCBS denied this stating "Patient age and procedure code are incompatible". Patient was 51 at the time of service. Dx used was V05.8. I can not find anything stating that this procedure is age specific. Thanks in advance for any help with this.

    Peggy Green, CPC
    Rome GA chapter.

  2. #2
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    Try the CDC - I don't specifically remember, but there might be something there about age recommendations. It is not in CPT, but if it's recommended for a certain age group by the CDC the insurance is not going to want to cover it outside of that range...
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Join Date
    Apr 2007
    Location
    Minneapolis
    Posts
    328

    Default

    90736 is for age 60 and over. That is the note we have by the CPT on our charges, so I'm thinking that came from the CDC.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. #4
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,128

    Default

    http://www.cdc.gov/search.do?queryTe...rchButton.y=13

    1st link...it's a Power Point presentation....4th slide

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