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Billing 96372 and a 90460 on same claim
90460 denials from McKesson edits
We billed
99394-25
90651
90460
This is the way we have always billed it but the edit response McKesson give is:
Response:
According to CPT guidelines published by the AMA, "Codes 90476 – 90748 identify the vaccine product only. To identify the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90748 must be used in addition to an immunization administration code(s) 90460-90474." In addition, according to CMS, codes G0008 – G0010 represent vaccine administration only. Thus, these codes may also receive a recommendation for denial when submitted without their primary vaccine or toxoid supply code.
This claim line was recommended for denial because the vaccine product code was not submitted with the appropriate associated vaccine administration code.
Therefore, procedure 90460 is disallowed.
Anyone having this issue or can assist in understanding why and what to do?
90460 +90461
so example MMR vaccine would be billed as follows;
90707 (3 components)
90460 x2
90461 x1
and other example
90697 (6 components)
90460 x1
90461 x5
so we are getting paid base on the components of the vaccine? So my provider thinks if we give 1 vaccine we would bill for 1 administration code and 1 vaccine regardless of the components.
i need clarification maybe examples please help