# Wi medicaid denials



## jeaner54175@yahoo.com (Feb 20, 2015)

We had a husband and wife come in on the same day for preventive visits. Each had flu shots and labs done. WI Medicaid is denying the 90471 for both, the flu vaccine codes used were 90656 and 90658. Also denied was the venipuncture code 36415 when coded with 85025 (CBC). Does WI Medicaid follow Medicare guidelines for venipuncture codes and reimbursement as well as bundling the administrative code for flu vaccinations into one reimbursement fee?

Any insight will be helpful,
Lisa Nieft


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## Rudolph.Dmello  (Feb 28, 2015)

*Forward Health WI - online handbook for providers*

Hi Lisa,

Forward Health Wisconsin has online handbooks published, and under Badger care Plus and Medicaid has the following guidelines:

Immunizations:

Topic 503:

Providers are required to indicate the code of the actual vaccine administered, not the administration code, on claims for all immunizations. Reimbursement for both the vaccines when appropriate, and the administration are included in the reimbursement of the vaccine code, so providers should not bill the administration code. Providers are required to indicate their usual customary charge for the service with procedure code.

Medicaid reimbursement for immune globulins, vaccines, toxoid immunization and the unlisted vaccine/toxoid procedure codes include the reimbursement for the administration component of the immunization contrary to the CPTs definition of the procedure code. Procedure codes for administration are not separately reimbursable.

Note: This section continues with separate guidelines with Vaccines for children 18 years and younger followed by members 19 years and older.

Venipuncture:

Topic #51

Services Not Separately Reimbursable

If reimbursement for a service is included in the reimbursement for the primary procedure or service, it is not separately reimbursable. For example, routine venipuncture is not separately reimbursable, but it is included in the reimbursement for the laboratory procedure or the laboratory test preparation and handling fee. Also, DME delivery charges are included in the reimbursement for DME items.

Thanks,
Rudolph


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## jeaner54175@yahoo.com (Mar 2, 2015)

Thank you!


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