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Tricare Flu Shot denials

  1. #1
    Jackson, TN
    Default Tricare Flu Shot denials
    Medical Coding Books
    We started getting denials on Tricare flu shots date of service startign mid Septemebr of 2011, so pretty much the start of flu season. We are using 90471 and 90658 with dx: ,v04.81... just like we did last year and got paid. When we call they will sometimes state it is an NCD # or sometimes they say it is the cpt codes. Can anyone help with this?

  2. Lightbulb
    We started getting the same denials last year as well and found out that there were new Q codes. Check your HCPCS book for Q2035-Q2039 for the appropriate flu shot. After doing that we got paid by Tricare. Your administration code and DX code is still the same. Tricare is the only insurance I use those codes for.

    Good Luck!

    Ann Foreman, CPC
    Financial Coordinator
    Loveland, CO

  3. Default
    Oct 1, 2011 - Tricare requires that the NDC# of the flu shot be on the claim form.

  4. #4
    Default Tricare Flu shots
    Q codes are also required for DSHS, Regence Healthy Options, Tricare and Medicare in Washington state.

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