Wiki Humana not paying for WCC when immunizations billed

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PediCoder

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Even though we have modifier 25 on the preventive visit line, lately Humana has been denying it saying, "This procedure code was not reimbursed because the service was included in another service provided at the same time." Any suggestions?
 
having the same issues here and kind freaking out about it. there doesn't seem to be any rhyme or reason to it. I feel its a claim system edit issue, I just don't know where to begin on getting it fixed. we have close to 60 claims now :(
 
We discovered this issue last week and have been trying to find out who our provider rep is now to get more info on it. There is a new NCCI edit that I found on the Humana website. This is the link: https://www.humana.com/provider/med...dits/search/notification-details?PolicyID=225
Hopefully our administrator who has made some calls about this finds out some info soon. I will update you guys if I hear anything else.
 
I looked up the NCCI Edits. I think someone at Humana has made a booboo. I would like someone else to read this and see if they catch the same thing I did. I have also sent CMS an email regarding this. on the NCCI Edits it says that CPT code 99211 is not separately reportable with 90460-90474 it does not say that you can not bill well visits with immunization codes. I also had a visit that denied and it was a follow up with a 25 modifier and the flu shot and immunization. It did not cover the immunization. The NCCI edits state that you can bill them if it is significant and separately identifiable, in which you should append a 25 modifier. Humana also denied my claim like that. For some reason it will not let me post the link.
 
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