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I am inquiring about billing for Adult Medicaid flu. We currently roster bill Medicare for our flu but want to start billing Medicaid adult. Do I bill through EMOMED using the appropriate procedure codes and modifiers? Or do I need to do something different? Thanks for the help!!
I bill through EMOMED using the pharmacy application. You will need to provide the NDC number of the vaccine, remembering the 5-4-2 method, i.e., xxxxx-xxxx-xx. Lead each section with zeros, if you have to, to complete the 5-4-2 method. There is no funding for payment of the administration fee.
I billed a regular and a high dose last week and will get paid barely $2 more than the vaccine cost me. Sad, but I’m going to do it anyway!
We have never had good luck billing Medicaid Flu shots for adults. We never seem to get any reimbursement. Haven’t tried this year but got burned the last 2 years, so we are done trying.
Straight Medicaid or the managed care companies will reimburse 90471 for the admin fee of an adult flu shot. The actual vaccine for adult flu will always be billed pharmacy to straight Medicaid, even if the patient has a managed care company. You will need to include both lines – 90471 and vaccine 90686 on the admin fee billing in order to get paid. We have no problem getting reimbursed as long as the patient doesn’t have limited benefits. Feel free to contact me if you have other questions. Brenda.phillips@capecountyhealth.com
We never get paid for the vaccine no matter how I enter it but they will pay the admin 99211. So you can have them pay the difference. I use emomed so i can see what it will pay but we dont get very many adult medicaid and have only had one so far. If you get a lot of adult medicaid just be careful you can end up losing a lot of money.
I spoke directly to Missouri HealthNet on October 10, 2019 regarding this exact question.
“Does Adult Medicaid pay for Influenza?” The answer is No. Medicaid will pay for children’s flu doses through the VFC program only. An administration fee, of $13.21 will be payable when administering an adult flu vaccine. If you have any further questions please give me a call, or email!Danielle Rosenkoetter, RMA
Medical Biller/ Coder
Registered Medical AssistantFranklin County Health Department
414 East Main Street
Union, Missouri 63084
Direct: (636) 584-6223
Fax: (636) 583-7305I’m sorry to disagree with Danielle, but I just filed claims last week with MoHN for adult regular and adult high dose flu. I am getting paid $48.50 for the high dose vaccine and $17.56 for the regular. It would not pay me for administration fees.
So, I am confused. If we have a 317 funded Adult Medicaid flu vaccine how do I bill for that? Then if I have a private pay flu vaccine given to an Adult Medicaid client, how do I bill for it? Is it entirely different? Do I file through pharmacy for both? And what procedure codes do I use for both situations? And do I need any modifiers? We don’t have very many but just trying to get these billed correctly. Thanks again for all your help!!
We are also getting paid for the vaccine ($16.07) as well as the administration fee ($12.71) for Adults on Medicaid. We file the administration fee as a medical claim and the vaccine as a pharmacy claim using the NDC #.
I bill the vaccine on a pharmacy claim. If I was filing an administration fee, I would file a medical claim.
Kathy, Here is a link to some Q&A for 317 vaccine. we also just started using it not long ago so Im new at it also. https://health.mo.gov/living/wellness/immunizations/pdf/section317faqs.pdf
I have never filed a pharmacy claim before. What boxes do I need to fill in to file claim for adult Medicaid flu private pay? I know I’m supposed to fill in NDC#, but what other boxes do I fill in besides name and DCN? This is not 317 funded.
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