Wiki Preventive Immunization billing for State Supplied Vaccines

[ethorsson@akpeds.com]

Our clinic uses the AVAP program in Alaska which means that instead of billing payers for the vaccines in our claims we only bill for the admin codes since the vaccines now come from the state. Since ICD-10 and the Z23 diagnosis code, we have been having a few issues with some payers not paying on them (I'm assuming it's because they have no idea which vaccines are being given since we omit the CPT codes for them). Our clearinghouse doesn't accept "zeroes" on line items themselves.... Just wondering if anyone else has this issue and a.) how are you billing for them b.) are you getting reimbursed? Thanks in advance

EDITED TO ADD: The vaccine administration codes are what we are having issues with getting reimbursement on

 

[sluke9]

Vaccines

When we bill for the vaccines we still put the CPT code for each vaccine. For 2015 the Medicaid plans in Ohio now pay the $10 reimbursement on the vaccine codes and not on the administration code. We still bill for both but write off the administration fee. If the carrier pays on the administration code and not the vaccine code I would still bill for the vaccine CPT's. This way they know which ones you are giving and you have a way of tracking which ones are given. If you are tracking manually this would be a back up. You can also check with the carrier's to see how they prefer them to be billed with the ICD-10 change.
Hope this helps.......

 

[CodingKing]

Here in MA we have a state supplied vaccine program for those that are insured and not insured. Its partially funded by the state and the insurance companies. We still use the SL modifier to indicate the drug was state supplied. For those that cannot bill $0, they bill us for $0.01 Either way our system is set up to reject based on code and age