# BCBS - Why won't they pay?



## kstine713 (Feb 24, 2017)

Hello, 

     Our office has been told by BCBS for years that they will never pay for 90461.  I don't understand how they can do this, when the number of vaccines we administer constitutes our usage of 90461.  I have tried to find this rule under their payer policies, but I can't find anything that states that won't pay for 90461.  Is anyone else having this issue??? 

     They have also said the same thing about extended hour/holiday codes - 99050 & 99051. Any help on getting these codes paid by BCBS would be MUCH appreciated! 


Thank you!


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## Cavalier40 (Feb 24, 2017)

Who is your local Blue?

Are you in network?


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## kstine713 (Feb 24, 2017)

BCBS of SC and yes, we are in network.


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## Pbhatt1 (Feb 24, 2017)

*Vaccines*

Is your practice enrolled in VFC program? If yes, then you must only bill administration code to the carrier or you may contact payer for further information.


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## Pbhatt1 (Feb 24, 2017)

*Vaccines*

Is your practice enrolled in VFC program? If yes, then you must only bill administration code to the carrier or you may contact payer for further information.


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## kstine713 (Feb 28, 2017)

VFC vaccines only apply to Medicaid patients 18 and under.  Private insurance is always billed for vaccines, and this is unrelated to the administration code - 90461, that we are trying to get paid.


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## cjtown (Feb 28, 2017)

*90461 and BC/BS*

90461 is an add on code for the vaccines.
_ For example, a patient gets the Rotavirus vaccine and the DTaP-HIB-IPV vaccine. The Rotavirus vaccine is a single component. The DTaP-HIG-IPV is a combination vaccine. It has five components. You would file the claim with 90460 x two units  (one unit for each vaccine) and 90461 x four units (the remaining four components for the DTaP-HIB-IPV)._ 
I found this on BC/BS website for your carrier. We have had the same issues with our Blue Cross carrier.  
Hope this helps.
Carla


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## kstine713 (Mar 1, 2017)

cjtown said:


> 90461 is an add on code for the vaccines.
> _ For example, a patient gets the Rotavirus vaccine and the DTaP-HIB-IPV vaccine. The Rotavirus vaccine is a single component. The DTaP-HIG-IPV is a combination vaccine. It has five components. You would file the claim with 90460 x two units  (one unit for each vaccine) and 90461 x four units (the remaining four components for the DTaP-HIB-IPV)._
> I found this on BC/BS website for your carrier. We have had the same issues with our Blue Cross carrier.
> Hope this helps.
> Carla



We are following the rules you mentioned and we are correctly adding on 90461 when appropriate, but they will never pay for it.  Your office does not get paid for 90461 from BCBS either?


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## Pbhatt1 (Mar 2, 2017)

*Blue plus?*

What plan type it is? is it Blue plus? If yes, then they follow DHS guidelines.


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