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What CPT code is everyone billing for an immunization visit?? CureMD has updated our code on the Superbill to 90460.
We’ve never billed 90460 before, it says: “counseling must be performed by a physician or other qualified health professional who is qualified by education, training, licensure/regulation who performs a professional service within her scope of practice and independently reports that professional service”
Is this right?? If not, what CPT code should we be using for immunization office visit w/ counseling instead? Is it the same for adults and children?
We always use 90471. They changed ours as well. I’ve noticed that it applies it to the superbill automatically if you select “counselling given”.
Now that we have an NP in the office we have debated billing 90460 instead, but it seems riskier. I’d be interested to hear what others are doing.
I had CMD remove the 90460 when I heard it required a physician and we bill the 90471 & 90472 instead.
I am still having trouble getting paid for administration for immunizations. United Healthcare Community Plan denied 90471, Healthy Blue wont pay any administration code (I’ve tried them all). Home state says use 99393 EP? Cure MD says to start calling the company’s and ask them what the code is. I have a pile of EOB’s on my desk with various companies none of them have paid administration costs. One EOB private UHC 90460 worked on one but not 2 others! Does anyone have any suggestions because Cure MD was no HELP.
You can’t use 90471 with any of the Medicaid managed plans. They will not pay it because you need to bill the correct cpt code with SL modifier for Medicaid kids getting vaccine through the VFC program. The code with the SL modifier is the administration fee you can bill for administration of the vaccine. Typically they pay about $8.07 per vaccine componet.
You can’t bill a 99393 EP unless you are doing an exam that correspondes to that cpt code.With any Medicaid plan we use code 99211 (at $20) for just a quick vaccine appointment. It pays out $19.16.
All Medicaid plans do not pay for any of the administration codes. Use the code for the vaccine with SL modifier. They pay any where from $8-$32 per vaccine plus the visit code.
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