All office visits – We only bill for code 99211 because we do not have a Dr onsite (we only have RN’s with standing orders). We get different amounts because the payments are based on age. Under 20 (with EP modifier) we bill/get $16.15 (the max you can bill for is $16.78), Over 20 we bill the $16.15 but only get $14.87 (the max allowed for this age group).
Vaccines – We bill for 99211 without a ht/wt – but we only do VFC and charge for the administration of the vaccine ($5 for each component). We have always done this – and have always billed/paid $16.15 (all managed care plans).
I was under the assumption from our billing seminar that the two touch rule (we do ht/wt) were only required to bill OV (99211) on WIC clients.
FYI – every January I check DSS for the most recent Fee Schedule for Medical Services – and if we need to adjust our fees we do.