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New CPT codes 90460 and 90461

  1. #41
    New Call-to-action
    I have only seen a few insurance plans actually saying how they will reimburse for these new codes, but here is the info I have! Hope it helps everyone!
    Cigna - "will not apply duplicate edits on these codes and will allow multiple submissions of these codes per claim"
    Anthem - "will be paying the lines for these codes unbundled. HOWEVER, when billing for HMO they do need to bundle these charges, so for HMO must bill multiples of the same code on one line with multiple units, or all additional lines will deny as duplicates"
    United Healthcare - "it is common coding practice for some CPT and HCPCS codes to be submitted with multiple units. However, when reporting the same CPT or HCPCS code on multiple lines and/or separate claims, the claim line may deny as a duplicate service. Maximum Frequency per Day values apply whether a physician or other health care professional submits one CPT or HCPCS code with multiple units on a single claim line or multiple claim lines with one or more unit(s) on each line for the same date of service for the same patient."

    My Anthem provider rep said "This billing methodology change will increase vaccine admin code occurrences by at least 82% in VA, which means a significant increase in payout to PCP's"

    Hope this info helps!

  2. #42
    MMR - measeles,mumps & rubilla ( 3 components)
    DTaP - diphtheria; tetanus & acellular pertusis ( 3 component )
    read the march edition of AAPC magazine. Every thing is explained clearly.

  3. Default
    Has anyone gotten any good responses to the new 90460 and 90461 CPT codes? Every insurance comapny that I talk to has a different response to how to code these from adding modifiers to bundling all the 90460's and 90461's with units. This is not what I was taught and there doesn't seem to be an end in sight on getting this issue fixed. Does anyone know when this might happen and what our options are regarding these codes? Cristina Lane, CPC

  4. #44
    Default immunizations and components
    I find myself referring to my CPT book to add up the components to bill these. Has anyone found a table that shows the # of components in each vac?

  5. #45
    Quote Originally Posted by View Post
    I find myself referring to my CPT book to add up the components to bill these. Has anyone found a table that shows the # of components in each vac?
    I went through the CPT vaccine section and made up an Excel sheet, but I can't attach it here. Send me a PM and I'll email it.


  6. #46
    Smile PM, thank you so much!

  7. #47
    Default admin codes help
    Quote Originally Posted by ksimpson View Post
    Is there an easy way to determine the number of components in each vaccine ? Is there a guide somewhere ?
    I can email you a spreadsheet someone sent to me if you give me your PM.

    Also i was wondering if providers, MAs or the billing staff was adding these admin codes?

  8. #48
    As long as an MD, NP, or RN document that they did the counseling, anyone can add the admin codes.
    Carole Sterling, CPC

  9. Question Billing of 90460 and 90461
    I seem to be having problems getting a grasp on how Medical Mutual of Ohio and Anthem for Ohio want these codes billed. It seems as though when I bill the 90460 as one unit on individual multiple lines they are getting denied as duplicate and then I am having to appeal them.

    Does anyone have a breakdown on how the major carriers want these codes billed?

  10. Default
    I just read that there has been a correction for the CPT 2011 book with regards to this:
    "On page 5 of the CPT Errata is the reference to vaccine immunization codes….”A component refers to all antigens in a vaccine that prevents disease caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.” Revise the immunization administration for vaccines/toxoids guidelines to include reference to all administration codes, and include reference to “all antigens in a vaccine that prevent disease(s)." Would you interpret this to mean that you go back to adding 90460 for the 1st vaccine and 90461 for each add'l vaccine as we did before 1/1/11?? Please let me know what you all think....

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