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modifier for 96372

  1. Default modifier for 96372
    Exam Training Packages
    Can someone please let me know if there is a new modifier that we must use when billing 96372 and a vaccine when the patient brings in the vaccine, we were told by tricare that we must use a modifier on the jcode showing the patient brought in the vaccine

  2. #2
    Default
    Quote Originally Posted by LDEPASS View Post
    Can someone please let me know if there is a new modifier that we must use when billing 96372 and a vaccine when the patient brings in the vaccine, we were told by tricare that we must use a modifier on the jcode showing the patient brought in the vaccine
    You don't bill 96372 for vaccine or toxoid admins. Only for therapeutic/prophylactic drug admins. If the patient brings in their own vaccine/toxoid product, I'm assuming they're over 18 (or if they're under 18, and no counseling is provided), so you would use 90471. If they're under 18 and counseling is provided, use 90460 for single vaccines, and add a 90461 for each additional component of a combination vaccine. You don't add a modifier, and you don't bill for the product. Hope that helps!

  3. #3
    Default *Clarification
    Tricare won't cover a vaccine admin without a product billed. There's no modifier for it.

    If they brought in a drug described by a J-code, the same principle applies, except you DO use 96372. Chances are, it 's not going to pay. You don't bill the J-Code, because you didn't provide it to the patient, if they brought it in themselves.

  4. Default 96372
    I am billing commercial, and have had a lot of providers say a mod is needed when billing this with an office visit now. Is there a new edit?

  5. #5
    Default
    Quote Originally Posted by jennruss View Post
    I am billing commercial, and have had a lot of providers say a mod is needed when billing this with an office visit now. Is there a new edit?
    You have to have a 25 modifier on the office visit - that's been required for as long as I've been in the business, which is almost 4 years. The admin shouldn't requie one, though. Hope that helps!

  6. Default
    thank you, it does, i did mean 90460-1 it was a vaccine, shingles, and tricare is trying to tell us there is a modifier that indicates that the patient brought in the vaccine, they are driving me crazy, but thank you, i was quite sure we only had to bill the admin code, and just omit the j code.......

  7. #7
    Default
    Quote Originally Posted by LDEPASS View Post
    thank you, it does, i did mean 90460-1 it was a vaccine, shingles, and tricare is trying to tell us there is a modifier that indicates that the patient brought in the vaccine, they are driving me crazy, but thank you, i was quite sure we only had to bill the admin code, and just omit the j code.......
    If there is one, it's a HCPCS modifier, and I don't happen to have that book with me. Check there, though. It'll be pretty specific.

  8. #8
    Location
    Lebanon, NH
    Posts
    17
    Question Correct code, they want more info?
    If I'm billing only the injection 96372 with the J-code because the patient brought his own serum (B12), where do I indicate if the injection was SC or IM? I've never had an insurance company need to know this before. The 96372 code indicates it's either SC or IM, but they want to know the 'method of injection'...........?

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