I’m hoping someone can clear up a conundrum for me. I have been told by our Billing department that the use of admin codes for vaccines are not to be submitted when done with an E&M .
As I understand the CPT codes 90460 for age 18 and under and 90461 for components and 90471 and 90472 for components for pt 19 and up are used when the patient/care giver is counseled regarding Immunization(including G0008/G0009 for medicare) Adding Modifier 25 on the EM is required.
Looking back at claims submitted for this year I’m finding that these codes have been removed, except for VFC When I questioned the billing dept I was advised that those codes can not be submitted with an E&M ,that 3rd party payers reject them. I find this hard to believe as even with VFC and use of SL modifier Medicaid covers the adm/counseling fee
I’m hoping someone might be able to shed more light at this point I feel we are missing revenue
Much appreciate your time
Cheri-CPC-A
As I understand the CPT codes 90460 for age 18 and under and 90461 for components and 90471 and 90472 for components for pt 19 and up are used when the patient/care giver is counseled regarding Immunization(including G0008/G0009 for medicare) Adding Modifier 25 on the EM is required.
Looking back at claims submitted for this year I’m finding that these codes have been removed, except for VFC When I questioned the billing dept I was advised that those codes can not be submitted with an E&M ,that 3rd party payers reject them. I find this hard to believe as even with VFC and use of SL modifier Medicaid covers the adm/counseling fee
I’m hoping someone might be able to shed more light at this point I feel we are missing revenue
Much appreciate your time
Cheri-CPC-A