Wiki Modifier Quandry for Medicare

[moremopars1]

This claim keeps getting kicked out. We gave a Pneumovacc 90732 with the G0009(Admin) and a Hep V Vaccine 90746 with 90471(Admin) and then a TB placement 86580. I have tried using 90472 in place of the 90471 secondary vaccine and got a denial. I then tried putting a 51 on the 90471 and 59 on the 86580 and got a denial. Can someone please tell me how to get this claim paid and where and what modifiers to use? I am pulling my hair out about this one!!:

 

[kbarron]

Hep A is not covered by Medicare neither is TB

 

[dballard2004]

I am going to assume here that when you state you are using code 90746, you are giving the Hep B vaccine, correct? Medicare does cover the Hep B vaccine (check your carrier for coverage criteria), but I think your problem here is the use of code 90471. The Hep B vaccine requires the administration code of G0010.

Hope this helps.