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Billing medicare for multiple vaccinations

  1. #1
    Angry Billing medicare for multiple vaccinations
    Medical Coding Books
    I am attempting to bill medicare for multiple injections and not succeeding.

    The patient received an flu shot (G0008 and 90658) as well as a Decavac (90714) on the same day. I billed CPT code 90471 for the administration of the Decavac and medicare denied.

    I know that medicare is not going to cover the Decavac (90714) but will pay for the administration. I have several examples of patients who ONLY received the Decavac and the admin was paid but the vaccination was denied.

    See example below:

    1014 101410 11 1.0 36415
    1014 101410 11 1.0 G0008
    1014 101410 11 1.0 90658
    1014 101410 11 1.0 90471 REM: M80
    1014 101410 11 1.0 90714 0 PR-204

    Medicare denied as M80...not billable during same session, but I KNOW THAT THEY WILL PAY IF THE FLU SHOT WAS NOT DONE ON SAME DAY...so why wont they pay with another injection?

  2. #2
    Default
    Quote Originally Posted by lmlaprise View Post
    I am attempting to bill medicare for multiple injections and not succeeding.

    The patient received an flu shot (G0008 and 90658) as well as a Decavac (90714) on the same day. I billed CPT code 90471 for the administration of the Decavac and medicare denied.

    I know that medicare is not going to cover the Decavac (90714) but will pay for the administration. I have several examples of patients who ONLY received the Decavac and the admin was paid but the vaccination was denied.

    See example below:

    1014 101410 11 1.0 36415
    1014 101410 11 1.0 G0008
    1014 101410 11 1.0 90658
    1014 101410 11 1.0 90471 REM: M80
    1014 101410 11 1.0 90714 0 PR-204

    Medicare denied as M80...not billable during same session, but I KNOW THAT THEY WILL PAY IF THE FLU SHOT WAS NOT DONE ON SAME DAY...so why wont they pay with another injection?
    Add a 59 modifier to 90471 - see the NCCI edits for physicians, under the medicine section 'mutually exclusive' list. Hope that helps!

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