Medicare Compliance & Reimbursement
Don't Forget Zip Codes When Submitting Flu Vaccine Claims
Claims for services outlined and payable under the Medicare Physician Fee Schedule (MPFS), like flu vaccines, must include the zip code locality, reminds one Medicare Administrative Contractor (MAC). Part B MAC NGS Medicare recently discovered that the payment in Massachusetts for three flu vaccine codes would be updated and figured differently according to the two distinct facility localities. The following HCPCS codes are impacted: Because the two locations refer to the greater metropolitan area of Boston (01 locality) and the remainder of the state of Massachusetts (99 locality), the allowed charges do vary based on the geography, NGS says. Reasoning: Reimbursements for MPFS services, even for the same code, can be significantly different depending on the location where the service was rendered. Providers in all jurisdictions should review flu vaccine coding in correlation to their facility’s location for precise reimbursement amounts. Remember: On the CMS-1500 claim form, you must put the complete address and zip code in either Box 32 (paper form) or Loop 2310C (electronic form), NGS indicates. The change goes into effect on July 15, 2019. Read the NGS article at www.ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/news-alerts/news-articles/news-detail.
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