Wiki HELP!! VCF billing

[sluke9]

Can anyone tell me a resource to use regarding the proper billing for the vaccines under the VCF program? I'm specifically looking to find out whether the vaccine should be billed with the normal fee that is charged and then adjusted off when we get the Medicaid denial or billed with a $0 or $.01 charge for the serum. Everything I find is about the administration codes and not the actual vaccine serum.

 

[kkvist]

Vfc

You should code the vaccine as you normally would with a $0.00 charge because if was supplied to you at no cost. Then bill the admin fee as usual with the following exception: Some states have a maximum allowable that can be billed for the administration. Check your contract to see this this could apply to you.

 

[sluke9]

Thanks, that is what I thought but the supervisor would like to know if there is anything in writing about it. A provider is billing the normal fee for the serum and then when the denial comes in, the charge is being written off.

 

[shellysk8]

Vfc

Check the payer website. Some payers require billing with a penny or dollar amount because there system cannot process the claim with a zero charge. Also be sure to use the VFC appropriate modifier SL (meaning "state supplied" but varies in some states).

Thanks,
Shelly

 

[slik]

You could also check with your VFC rep if you know who that person is - sometimes they can offer valuable information & tips.