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Thread: 90471 and 90472 denied when billed with E/M

  1. #1

    Default 90471 and 90472 denied when billed with E/M

    AAPC: Back to School
    Why CPT 90471 and 90472 is not paid when billed with office / preventive visit. Any modifier required ?

  2. #2
    Join Date
    Apr 2007

    Default 90471 and 90472 denied when billed with E/M

    We use mod-25 with OV code when we bill CPT 90471 with OV code. But, while billing CPT 90471 with preventive exam we don't use any modifier with preventive exam CPT.
    Om CPC

  3. #3
    Join Date
    Apr 2007


    I agree with Mr. Omprakash

  4. #4


    What are we supposed to do if denied even after using mod 25

  5. #5

    Thumbs up

    You need to check age of the patient while using cpt 90471 & 90472. If patient is less than 8years than u need to use 90465 & 90466. Also u need to have separate dx for office visit if u r using modifier 25.
    Sometimes it is insurance specific, some insurance only pay vaccines but not the administration. You need to check with the insurance company whether it is covered under patients plan or not.

  6. #6


    What if everything that you are saying is right in place & still there is denial?

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