# Vaccine for children



## alessandra (Jan 29, 2016)

I live in NJ and I work for a pediatrician. We have a large number of patients with Horizon NJ Health. How do you bill the Vaccine from the state? I`ve been using the Mod SL attached to the vaccine and has been denied. Example: 90672,SL
90473
90707,SL
90472
I need help. Any suggestions?


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## Knm5800 (Feb 1, 2016)

What is the denial reason?  Are you billing the admin code (90460) for the vaccine as well?  If your office particiaptes with your state's VFC program, you generally only get paid for the admin of the vaccine as you are (should) not be using private stock.  You should be receiving VFC vaccines directly from your state.


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## alessandra (Feb 3, 2016)

They are saying I`m using the wrong Modifier SL(State supplied) $0 charge. I`m using the Adm code 90460-904610 or 90471-90472


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## CodingKing (Feb 3, 2016)

I'm confused. The drug is state supplied, you put on the SL modifier and billed $0 because its free of charge. Of course its not going to pay so i'm not sure what the issues is. We have similar program here in MA and we just deny the state supplied vaccine line with a message that its state supplied.


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## alessandra (Feb 4, 2016)

I will give you an example. A patient came in for a WV with vaccine:
99392,25
90672,SL
90460
The insurance is not paying the ADMIN code. This is what they are sending
The modifier and procedure code on the charge are incompatible. [MODCPTMATCH]
The payer indicates that the modifier and procedure code on this charge are incompatible. Please correct the error, save the claim, and drop the claim with DRPBILLING.
As per eob under payment batch # 14178 found cpt 90460 was denied on 01/19/2016 as Missing/incomplete/invalid type of bill. As per payor cpt 90460 was denied because the vaccine code denied as invalid cpt modifier combination. Therefore review and update the appropriate modifier for the vaccine code. Once done resubmit as corrected claim to po box 7117 London KY 40742 or payor ID # 22326 time limit is 365days from denial date. Please r. Once done kick the claim with DRPBILLING. Thank you.


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