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Zostavax coding-Part D Drug

  1. Default Zostavax coding-Part D Drug
    Medical Coding Books
    I am told by Medicare Part B, that my IM doctors should not bill the Zostavax and administration as it is covered under Part D-Prescription Drug Plan. I am having a problem with the patients being able to get the claim to their secondary who may cover it. We ask the patient to pay up front in full.
    I cannot bill to MCR and get a denial to bill secondary because admin code G0377 is no longer valid and 90471 gets paid in error and then we have to go through that whole hassel.
    How do you do it?

  2. #2
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default Zostavax
    We have the pt pay up front. When they call to make an appointment, they are told that the need to pay up front. As of 1/1/8 MCR will not pay for the administration or the vaccine. This is preventative and therefore not covered. Good Luck.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. Default
    I work for a group of Family Practice doctors, if the patient has Part D coverage, the patients doctor calls in a script for the vaccine to a local pharmacy for the patient to pick up and bring into our office to administer.
    There are certain guidelines that need to be followed as far as, the amount of time the patient has between picking up injection and administering the injection. The pharmacy will run there Part D insurance and in some cases
    the patient only pays a copay, but not all. The patient will still be responsible for the administration fee. Hope this makes sense.

  4. #4
    Location
    Visalia, CA
    Posts
    30
    Default
    Our providers also write an RX for the patient to purchase the vaccine from a local pharmacy. However, we just had a meeting with one of the Merck reps and was told that there is a new Portal for physicians to be able to bill Part D. I have been a bit skeptical so have not signed on to do this. I would pursue your Drug Reps for the information.

  5. #5
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default Zostervax
    Beware of what the "Drug Reps" tell you. They want the MD to use their product. I have had a couple of instances that I was given wrong information as to what and how I should bill. CMS mandates the way to bill medications.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    Default
    I agree with Karen. We were told about the Portal and tried to use it and ended up with a mess. It took some time to get it straightened out.

    Teresa Collins, CPC

  7. Default
    We also have the patient pay up front for the administration, and only charge the medicare allowable fee for 90471, because Medicare will not pay for the injection. Since Medicare part D pays for the vaccine we also right the script and have the patient pick it up and bring it in for the injection, as was stated in a previous post.

  8. Default Administration
    The problem is that MCR will pay the administration, because they do not have an edit in place that will deny it. But, the administration of a Part D drug is not a covered expense under Part B, so we should not be accepting that payment from Medicare.

  9. #9
    Location
    NCF Gainesville
    Posts
    64
    Default
    Quote Originally Posted by jluther View Post
    Our providers also write an RX for the patient to purchase the vaccine from a local pharmacy. However, we just had a meeting with one of the Merck reps and was told that there is a new Portal for physicians to be able to bill Part D. I have been a bit skeptical so have not signed on to do this. I would pursue your Drug Reps for the information.

    This issue has been going on since the Zostavax vaccine came out....seems you have good reason to be skeptical.
    The easiest way for the patient, and the biller, is to have the patient pick up the meds from the pharmacy.
    Jeni Smith, CPC, CPMA

  10. Default zostavax
    i was taught that the physicians should be writing scripts for the Zostavax, let the pt pick it up at the pharmacy........because their Part D will pay there. Then have them come to office for the administration. No loss to office, no loss to patient.

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