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Thread: medicaid/modifiers

  1. #1

    Default medicaid/modifiers

    AAPC: Back to School
    I am trying to get back the most for our injections with administration.

    When baby comes in for well visit and has shots should the coding look like this

    99391 - EP
    90669 - SL

    Please help i am new to pediatric coding and could use some assistance

  2. #2

    Smile Medicaid / Modifiers

    Please try following steps for coding :
    1. Select age appropriate Preventive Medicine / well visit CPT code.
    2. If the vaccine is supplied by State then only add SL modifier.
    3. If baby is younger than 8 years use vaccine administration code 90465 for first vaccine & 90466 for each additional vaccine.
    4. If baby is older than 8 years use vaccine administration code 90471 for first vaccine & 90472 for each additional vaccine.

    99391 - EP - V20.2
    90669 - SL - V03.82
    90465 - V03.82

    All The Best !
    Neha Bhatnagar, CPC, CPC-H

  3. #3
    Join Date
    Apr 2007
    St. George Utah Chapter

    Default Medicaid and Modifiers

    Remember that your preventive care codes 99391-99394 include the ordering of age appropriate vaccines and therefore you do not need to add the V-code for the vaccines given. This saves a lot of time and effort, instead of creating additional claims for the vaccines alone.

    Hope this is helpful,


  4. #4
    Join Date
    Apr 2007
    Seacoast- Dover New Hampshire


    Melissa, Where is this in writing, not using the v code? We have a person who stated that you need to code each vaccine. I had seen this somewhere and cannot locate it. Also be carefull because some states supply vaccine for children up to their 19th birthday.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
    Join Date
    Apr 2007
    North Carolina


    Although I am in a different state than Melissa, looks like our carrier has the same guidelines.


    Beginning on page 25

  6. #6
    Join Date
    Apr 2007
    St. George Utah Chapter

    Red face

    I misspoke with the preventive care; your V-codes state immunizations appropriate for age. For years we billed out 2 seperate claims with all the immunizations listed, until a couple of us attend a seminar presented by Donelle Holle, RN Coding and Remibursement Specialist. She pointed out that the V20.2 ROUTINE INFANT OR CHILD HEALTH CHECK"Developmental testing of infant or child; Immunizations appropriate for age; Initial and subsequent routine newborn check; Routine vision and hearing testing"

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