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Medicare Advantage Flu Shot Billing and Modifiers

  1. #1
    Default Medicare Advantage Flu Shot Billing and Modifiers
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    We are being told by our Coding department that the GA modifier needs to be added to the G0008 charge for Flu Administration. Has anyone heard this?
    This is what I got from my coder:

    "Patient came in last year and got a flu vaccine, Pneumonia vaccine, and DTap vaccine all on the same date. Medicare is now stating that G0008 & G0009 must have a modifier attached because they are being billed with 90471. Does anyone know what modifier they are looking for? Thanks for your help.
    You need to bill with GA modifier with "G" CPT codes because 90471 is mutually exclusive with G codes as per Medicare."[/B]

    Here is what was billed:
    G0008
    Q0238
    90471
    90715
    99214-25

    We are getting an edit in our billing software (CCI Edit) that a mod is needed on G0008. What would be appropriate mod?
    Last edited by kschulte71; 10-31-2018 at 10:30 AM.

  2. Default
    I've not had any trouble with reimbursement without a modifier for the flu code for our Medicare Advantage patients; that's odd. Curious to see what others say....

  3. Default
    Without being familiar with your EHR, try changing the 90471 to a 90472 and see if that clears the edit

  4. #4
    Default
    When billing for 90471 with G0008/09 you need to add modifier 59 to the G code

    Traditional Medicare does not pay for TDaP unless it is given due to a wound to prevent infection

    Hope this helps

  5. Default Fqhc flu vaccination
    HELP,
    having problems understanding how to exactly bill or get paid for Flu vaccination. We (FQHC) bill G0008 w/ Q2038/9 depending on the age. We are having a hard time getting reimbursement. We do use modifier 25 if 90741 on the claim. Can someone that work with FQHC explain how flu vaccination should be billed. Thank you

  6. Default
    Medical Billing
    If you are an FQHC, the flu shot is part of the encounter, not reimbursed separately. The cost of the flu shot and administration will be reported on your cost report.

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