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Practice Management Alert

Reader Questions:

Follow Payer Policy Even If It Goes Against Coding Guidelines

Published on Thu May 12, 2011

Question: Our Medicaid carrier refuses to accept the new vaccination codes, but we know it's correct coding to report them. Should we report 90460-90461 to Medicaid and appeal any denials?Oregon SubscriberAnswer: You should not go against your local payer's advice -- if your Medicaid carrier will not accept the new codes, then you should report only the codes they advise.For instance: Oregon's state Department of Medical Assistance Programs office instructs on its Web site that practices should continue reporting immunizations the same way they did last year, despite the new codes. "Do not use the new CPT codes (90460-90461) available for children's immunizations," the payer's site instructs. Instead, Oregon's Department of Human Services notes that practices should "continue to bill immunizations with the specific vaccine administered and add modifier SL or 26." (See https://apps.state.or.us/cf1/OHP/OHPadmin/files/pm0111.pdf for the complete directive).In other cases, some state agencies may choose to pay one of the [...]
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