Vaxelis billing

[Missouri Public Health Association]

Is anyone else getting anything like this, it is from our billing team? Patient has United Health Care.

Yes, we are billing the right code which is 90697, and according to CMS guidelines, the CPT code description is [Dtap-ipv-hib-hepb vaccine im]. As per CMS guidelines [CMS Article A56900 – Group 2, file Page #4], the following procedure code represents immunization that is considered routine preventative immunization, or it is not a disease entity endemic in the United States and therefore is not covered. Please select reimbursable ICD from the Group 2 ICD list [file page #75] or suggest further.

[Missouri Public Health Association]

Is it UNHC? I haven’t seen that yet, but they were denying payment for a while on this vaccine. I called several times, sent appeal and paper billed. Have finally got reimbursed for several of them.

[Missouri Public Health Association]

Ya and it’s United Health Care Community Plan, and they have always paid $20 on it before.

[Missouri Public Health Association]

We haven’t had any issues and get reimbursed $32.20. what denial codes are you getting? Im sure you have checked but verify age, it covers 6 weeks-4 years.

[Missouri Public Health Association]

The child was 6 months old, and they are denying it because they say it is “the following procedure code represents immunization that is considered routine preventative immunization, or it is not a disease entity endemic in the United States and therefore is not covered.”

[Author]

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