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Medicare Vaccine billing help

  1. #1
    Default Medicare Vaccine billing help
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    Please help!!

    Medicare Patient brought in Zostavax vaccine for our nurse to administer. I sumbitted the claim with 99211, 90736 - $0, and V04.89, but the claim was on hold in our system because "If a physician sees a beneficiary for the sole purpose of administering the influenza virus vaccine, the pneumococcal vaccine, and/or the hepatitis B vaccine, they may not routinely bill for an office visit. "

    Can someone help me figure out how we can bill for this? Thank you very much!!

  2. #2
    Location
    Columbia, MO
    Posts
    12,570
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    you cannot bill a 99211 to administer an injection of any kind you use the injection administration code and vaccines have specific vaccine administration codes.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    So this claim is not billable?

  4. #4
    Default
    I've come across this with a different injection before. Try doing the Zostavax code for $0, and then the appropriate injection code (I'm in chiro now and can't remember what it is! ) Good luck!

  5. #5
    Location
    Columbia, MO
    Posts
    12,570
    Default
    no you will need to change the 99211 to a vaccine administration code such as 90471.

    Debra A. Mitchell, MSPH, CPC-H

  6. Default
    Quote Originally Posted by suishay View Post
    Please help!!

    Medicare Patient brought in Zostavax vaccine for our nurse to administer. I sumbitted the claim with 99211, 90736 - $0, and V04.89, but the claim was on hold in our system because "If a physician sees a beneficiary for the sole purpose of administering the influenza virus vaccine, the pneumococcal vaccine, and/or the hepatitis B vaccine, they may not routinely bill for an office visit. "

    Can someone help me figure out how we can bill for this? Thank you very much!!
    You do not code a 99211 for a vaccine only. It is included in the administation, which by the way you left off. You need to code 90471 for the admin of the vaccine.

  7. #7
    Default
    Thank you very much for all of your helps

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