Wiki BCBS denying vaccine admin codes

[MMyers20]

We're getting payment denials for vaccine administrations (90471) from Blue Cross Blue Shield. They're saying the cost is bundled, but we're not sure if it's bundled into the vaccine or the visit. The denial states we can appeal the decision with further documentation. Has anyone experienced this, and if so, were you able to get paid for both the vaccine and the admin? What sort of documentation might they be looking for? Thanks in advance for any help.

 

[iowagirl77]

The E/M code bundles to 90471. Was a 25 modifier used on the E/M code? If not, review to see if they are separately supported (the patient didn't come in just for the vaccination alone); if both are supported, add a 25 modifier to the E/M. If a 25 modifier was used on the E/M but it still denied, review to see if there are any other services it could be bundled to. If there is nothing else and they are separately supported, appeal with visit documentation. Some payers are cracking down on the overuse of modifier 25 and may want documentation.