Wiki HPV denials for adults

[ellistneal]

We are getting denials from several insurances for the billing of Gardasil injections. Should I use another diagnoses beside Z23. FYI, we are an infectious disease specialty. What would be other reasons for the denial?

 

[thomas7331]

Z23 is correct unless the vaccine is being given to treat an existing illness or known exposure.

What reason are they giving you for the denial? Many denials have nothing to do with the way you are coding and billing. It’s possible that the patient just doesn’t have this benefit from their plan.

 

[ellistneal]

Z23 is correct unless the vaccine is being given to treat an existing illness or known exposure.

What reason are they giving you for the denial? Many denials have nothing to do with the way you are coding and billing. It’s possible that the patient just doesn’t have this benefit from their plan.

 

[ellistneal]

So after calling Oscar, they state the 90651 was not submitted and instead the admin code was submitted twice (which is untrue). Their remittance also show the code submitted with the admin code. At this point, I will appeal the denial. Thank you for your insight.

 

[csperoni]

In my experience, some insurances will not cover Gardasil for patients over age 25, even though it was FDA approved several years ago to be given to age 45. In fact, some physicians even recommend off label use for it for older patients with cervical intraepithelial neoplasia to help mitigate further progression.