Wiki United HealthCare Community Plans

[t.rodgers@nwbchcc.org]

I am getting rejections from UHC community plans for 90471 and 90472. How do I bill properly for the admin? I was billing MOD 25 on the primary line then was told no, MOD 25 should go on the admin line 90471 and 90472. Still denied. How is everyone else billing for this services and getting reimbursement?

Thank you

 

[Cynthia Hughes]

You can find published UHC reimbursement policies at uhcprovider.com. However, not everything is addressed in the published policies.

Were the vaccines provided as part of Vaccines for Children? If so, follow state-specific directions. UHC Community Plans policy says the following for New York.
New York requires the SL modifier be appended to the vaccine serum code. If the SL modifier is not appended, the serum code will not be counted and the corresponding administration code will be denied.
New York will only reimburse administration code 90460 for VFC related vaccines.

If not provided as part of Vaccines for Children, was the "primary line" a preventive E/M service code reported with modifier 25 appended?

 

[t.rodgers@nwbchcc.org]

Thank you. We do not use the 90460 since our providers do not educate the patients on the vaccines from what I am told. Therefore, we reverted back to 90471. The shots are given as the VFC program. I know MCD that is how we have to bill with the SL modifier and the 90460. We bill our other MCD Managed plans using 90471 and the VFC and they are reimbursed.