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I am having issues with MO Care managed care plan when billing immunizations, I am getting “Procedure Code in Service Line >> HCPCS Procedure Code is invalid in Professional Service” I am not sure what that means and I am doing WIC billing for office at the same time but adding the 25 Modifier to show it is a separate billing, When I call Mo care of course they are saying ” I am sorry I cant help you with billing” I would love any help at all!
I use the procedure code for the immunizations and SL for the modifier when I bill for them. SL means it is state supplied vaccine.
If you are billing for a WIC visit where immunizations were given, you bill the diagnosis code of Z02.9 with a CPT code of 99211 EP for the visit, and then the diagnosis code of Z23 for immunizations, the CPT code for the particular vaccine, using the SL modifier. They should pay this way. You can’t bill a separate administrative fee for the WIC visit and the immunization visit when they were done at the same time. I hope this helps, along with the other information the ladies provided. Good luck!
I am new to our health department. Has anyone had issues with Mo Care denied for not having the SL modifier?
Jill, yes and it is due to the SL is State Lot and Mo care is only medicaid managed care billable. Hope this helps!
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