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Hi there,
Another question arose in a meeting today regarding blood draws, finger pricks, and injections. I have never had luck getting CPT codes 36415, 96732 and 36416 paid with Medicaid. I have heard other health departments have. What is the best way to handle these codes with Medicaid and for VFC claims? And are they billable to the patient or does anyone bill the patient for the injections if it is a VFC vaccine?
I just cant figure out what I’m doing wrong if they are payable.
ThanksIf a patient comes in for a VFC vaccine, you will bill the MC+ plan $25.00 for the administration under diagnosis code Z02.89, CPT 99211. Then you bill for the vaccine using diagnosis code Z23, CPT 90700 SL (this is the code for DTap) or whatever vaccine, for whatever amount. Use the SL modifier for vaccine provided by VFC.
If your agency purchased the vaccine, i.e., flu vaccine, you will not use the SL modifier.
Do not use the SL modifier when billing for COVID vaccine.
If you use VaxCare or some other vaccine provider service, you will not bill MC+ at all.
Hope this helps. Call me anytime, I’m glad to help! 660/327-4653 x 240
We bill 99211 as an encounter and get about $15.31 which doesn’t cover the cost but it is more than nothing.
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