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Vaccine codes and Modifier 59

  1. #1
    Exclamation Vaccine codes and Modifier 59
    Medical Coding Books
    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
    Columbia, MO
    that is correct the first 90472 does not need any modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    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. Default
    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. Default
    I agree with regards to the addition of -25 and no -59 needed.

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