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Thread: Vaccine codes and Modifier 59

  1. #1
    Join Date
    Apr 2007
    Houston, Texas

    Exclamation Vaccine codes and Modifier 59

    AAPC: Back to School
    Hello everyone! In need of help ASAP!

    99214 - Est. Level 4
    90746 - Hep B
    90471 - Admin >8 yrs old
    90632 - Hep A
    90472-59 - Add-on

    Anthem paid the office visit but not the vaccines and admins. This is how it was originally billed. Now if I'm not mistakened, the add-on code 90472 doesn't need a modifier does it?

    I need clarification! Thanks!

    Sarah Mc.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    that is correct the first 90472 does not need any modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Temple, TX


    that is correct, 90472 does not warrent the use of any modifiers as it cannot be billed without a primary procedure being billed. The primary procedure for 90472 can be billed with any initial immunization cpt code.

  4. #4


    All of the payers I've ever billed to do not require any modifiers on the vaccines but do require a mod -25 on the e/m visit.

  5. #5


    I agree with regards to the addition of -25 and no -59 needed.

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