AAPC - Back to school
Page 2 of 2 FirstFirst 12
Results 11 to 15 of 15

Thread: Can someone please clarify 90472

  1. #11
    Join Date
    Apr 2007
    Greeley, Colorado


    AAPC: Back to School
    Quote Originally Posted by mitchellde View Post
    we may just have to disagree, the 1500 has its own billing manual that has been continuously updated thru the years. Many times you may have read the statement but it is subtle and many people miss it. However I discovered it when we continued to be under paid and or denied when this was done, I did a ton of research and finally deciphered the statement. They use the language of quantity distribution and then do not clarify what this is referring to. I am sorry that you disagree but I maintain the 59 modifier is correct regardless of which method you wish to use. I know several will continue to use units. So we will just have to let it go at that.
    Agreed. We will just agree to disagree.
    Lisa Bledsoe, CPC, CPMA

  2. #12


    I do realize that this is an old post, and I hate open a can of worms here, but I feel the need to chime in. CPT Assistant, November 2000 states that code 90472 is to be reported one time for each addtional vaccine administered. I agree that modifier 59 should also be used on each addtional 90472 code.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  3. #13


    I agree with the last poster. I am sitting here with a denial stating that the AMA defines CPT code 90472 as "...list separately in addition to code for primary procedure". They go on to state that "According to the MUE's, this code may be billed no more than 4 units per day for the same beneficiary." We billed 6 immunizations with 6 diagnoses and 90471 with 90472 X 5. Does anyone have a suggestion and I am not good at settling with the fact that we cannot bill the patient or we cannot expect to get paid for a service we performed and does anyone have a link to the MEU that states only 4 units per day allowed for the same beneficiary??

  4. #14


    We've never billed more than 3 units of 90472 so I'm not sure what to suggest. MUEs are in place to help reduce claim errors. Since your claim is not in error, see if you can appeal with medical necessity.

    The MUE is found here: CMS MUE LINK

    It does list 4 units for 90472.

  5. #15


    Thank you so much for your help, this finally paid.

Page 2 of 2 FirstFirst 12

Similar Threads

  1. 90471,90472
    By TLC in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 01-23-2013, 09:33 AM
  2. Gooo9/90472
    By DAPHNE JONES in forum Family Practice
    Replies: 2
    Last Post: 11-11-2011, 06:54 AM
  3. G0008/g0009/90471/90472- 59
    By mizzmaryb in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-05-2011, 05:22 PM
  4. 90472
    By dballard2004 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 10-15-2010, 12:57 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.