It seems like we talk a lot about immunizations. However, there may be opportunities to better assure you are receiving all the reimbursement you deserve. Please review the following tips and let us know if you have any questions.
When administering and injectable along with an oral/nasal inhalation immunizations your administration codes should be as follows:
Not providing counseling and/or the patient is over 18 year:
- 90471 (first injection
- 90472 (each additional if needed)
- 90474 (for inhalation or oral vaccine ) DO NOT USE 90473
Under 18 years and providing counseling:
- 90460 (first vaccine or toxoid, any route of administration(can be injection, oral or nasal)
- 90461 (each additional injection, inhalation and/or oral administration
Use the correct quantity for each scenario to capture each immunization provided
If the patient is coming in solely for the purpose of obtaining a vaccination (order was already established in the chart) you would NOT bill a 99211 or other E&M code with the immunization and administration codes. If there is another reason the patient is there and you provide the immunizations you can bill a 99211 or other E&M code using a diagnosis other than that for immunizations and append the E&M code with modifier 25 (meaning it was a separate service from the immunization administration and documentation supports the service).
For more information, please contact Jean Troop, MBA, RHIT, Director of Alliance Practice and Data Management at 517-908-0847 ext. 226, or email@example.com.
Reminder that Molina does require a prior authorization be obtained for any behavioral health service provided after the 1st visit. This includes the 20 visits authorized under Medicaid, per calendar year. If you have any questions regarding this please give us a call at 517 908 0827 x226.
Total Health Care has been denying code 90471 as inclusive when billed with 90472. This is an incorrect rejection. You may need to call THC to have them reprocess your claim. Code 90471 IS NOT inclusive to 90472 you should get paid for both.
Plan First-Medicaid—there are specific diagnosis codes (V25 series only) and CPT codes/services that are payable under Plan First. Click here and then go to the Covered Services section for specific information.
When billing for removal of impacted cerumen using code 69210, this code is now a unilateral code. If having to remove the cerumen from both ears make sure to use a quantity of 2 and a modifier 50 (bilateral) to receive maximum reimbursement.