Vaxelis

[Missouri Public Health Association]

Anyone having trouble with getting paid for this from United Health care? cpt 90672 SL modifier? united health saying not eligible due to patients age, patient was 3 months old

[Missouri Public Health Association]

90672 is for FluMist, right? That is only approved for ages 2 years through 49 years.

[Missouri Public Health Association]

Corrie is correct. FluMist is only for 2 years-49 years old and other flu vaccine is only for 6 months and older given is 2 doses. I dont believe theres any approved for babies under 6 months old at this time.

[Missouri Public Health Association]

How much are you charging for Vaxelis?

[Missouri Public Health Association]

90697 SL

[Missouri Public Health Association]

31.62 is what I have been getting paid

[Missouri Public Health Association]

Thanks!

[Missouri Public Health Association]

What is everyone charging Missouri Medicaid for Vaxelis?

[Missouri Public Health Association]

That is the correct CPT code for Vaxelis. I would call and see what the denial is really for because that is a valid code.

[Missouri Public Health Association]

That’s the code we use. What was the denial reason code?

[Missouri Public Health Association]

RMK CD : N418 (misrouted Claim.)
GRP CD/RSN CD : Claim/service not covered by this payer/contractor. I also billed for Rotateq and PNU-13 and UHC paid those.

[Missouri Public Health Association]

I have had the same issue. Did you find anything out?

[Missouri Public Health Association]

Are you including the SL modifier? I have not had an issue getting paid $32.26 for Z23 90697 SL

[Missouri Public Health Association]

Yes. Using the SL modifier. I will call UNHC. This is a recent issue.

[Missouri Public Health Association]

Yes I have used the SL modifier. I am on the phone right now with UHC.

[Author]

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