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When billing adult vaccinations to Medicaid, do you submit the vaccine admin codes to Emomed along with the vaccine CPT codes? We received a denial stating admin codes weren’t acceptable to bill on Emomed because they don’t have an NDC and are considered Medical claims not Pharmacy claims. Any assistance would be greatly appreciated.
When I bill for the admin fee for adult Medicaid, I just bill the 90471 without a modifier.
Then I go to the Pharmacy side for Medicaid and bill just for the vaccine.So you don’t enter the admin codes on Emomed at all, just let them go through your clearing house? The patient we are having an issue with has a Managed Care plan, so we billed straight MO Medicaid via Emomed for the vaccinations and admin codes. In that case, do you bill the admin codes to the Managed Care plan or keep with straight MO Medicaid?
The Admin code is billed on the Medical (CMS 1500) claim and the vaccines are billed on the pharmacy claim with the NDC.
Hi Dana,
We talked about this subject a couple of months ago but I still need some help. The billing company we are contracted with is stating that when we bill straight MO Medicaid, for adults with a Managed Care plan, for both the vaccine cpt code & admin cpt code, the admin codes are getting denied. According to the billing company, this is the denial they are receiving regarding the admin codes being billed:
”CO-24 : Charges are covered under a capitation agreement/managed care plan.” when patient has a Medicaid MCO plan to pay medical claims
What am I missing? What are we doing wrong?
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