Wiki Aetna denying Code 90660 for the Flu Mist

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Jenn79

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I am having trouble with Aetna denying CPT code 90660, all of our other payers are paying for this code. We are coding 90660 Flu Mist, with admin code 90460 or 90473 (no other vaccines are given), with DX code Z23. I cannot get anywhere with Aetna, they are just saying that it is payable if it coded correctly. Is anyone having this problem? We are billing for a pediatric office in Colorado.
Thanks, Jenn
 
What was the age of the patient who received the Flu Mist vaccine? 90460 is for patients through 18 years of age. If the patient is over age 18 then the appropriate admin code is 90473.
 
Ages are 3-17 years - We have only coded the 90660 with the admin code 90460 - we have a flu clinic coming up, and we will be charging the 90660 with 90473 (Immunization administration by intranasal or oral route; 1vaccine (single or combination vaccine/toxoid) without counseling. So far, the only edits I have received from Aetna is:
"This service or supply is not generally recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Please refer to our Clinical Policy Bulletin 0035 titled Influenza Vaccine for information on why this service is not covered. Clinical Policy Bulletin 0035 can be found at this web address:
http://www.aetna.com/cpb/medical/data/1_99/0035.html - Therefore, procedure 90660 is not recommended for payment."

However when I read Clinical Policy Bulletin 0035, 90660 is listed as a covered code.
 
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