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I am having the same issue. 90686 with SL Modifier (for vfc vaccine). VFC program verified that was the correct code to use. It is licensed for 6months and up so I don’t know what the deal is.
They are also denying hemoglobin’s on WIC clients?? Never had an issue before but suddenly they won’t pay for any of them.
Are you using VFC vaccine and if so are you using the SL modifier.
They reimburse $5.35 for the state supplied vaccine and that covers the administration cost.Just wanting to clarify for myself since my brain doesnt seem to be wrking lately lol. So, I understand I cannot bill 99211 for 90686 on offsite flu clinics…but am I not able to bill that for in office also?? Is the $5.35 considered the “office visit” or just the admin??
In years past I have used 90685 with modifier SL for children under 3 years of age. I had a couple of claims denied with 90686 so I will try the 90685.
We bill 99211 office visit and with adm fee for any vaccine the child gets. You can find CPT codes for correct vaccine on CDC website also https://www.cdc.gov/vaccines/programs/iis/code-sets.html
Had the same issue with one, then the next they payed without any problems. Not sure what the deal is.
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