Wiki BCBS denying mod 59 on vaccine administration code 90471

[Lynnctodd]

Recently, we have gotten several denials from various BCBS plans for modifier 59 on vaccine administration code 90471. The remark code says "procedure modifier was invalid on date of service". One patient called BCBS and was told modifier 59 is invalid on this service. Is this a glitch within BCBs or has something changed with modifier 59 guidelines? I've searched online and can't find any changes where I should not be allowed to use modifier 59 on the administration codes. Example of charges:

99215 mod 25
90670-for pneumonia vaccine medicine
90471 mod 59 for vaccine admin code

 

[Teresa Collins]

It has been my experience, with the codes that you have listed, that you do not need modifier 59 on the administration code. Since you have modifier 25 on the E/M code, BCBS should not bundle the E/M with the vaccine admin, making modifier 59 unnecessary.

I hope this helps.