Vaccines for Children Update

Posted February 15th, 2012 by mfoster & filed under Blog, Newsroom, Provider News, Uncategorized.

The Division of Medicaid (DOM) claims processing procedures were recently modified to be in compliance with the 2009 Code Update AMA change in regards to the billing rules for immunization codes 90471 and 90473.  The AMA ruling indicated only one or the other code can be billed on a single date of service.  The recent NCCI mutually exclusive ruling also mandates certain codes cannot be billed together by the same physician on the same beneficiary on the same date of service.

DOM claims processing system will evaluate all claims by the same physician on the same beneficiary on the same date of service.  If a claim is found which indicates one of the codes has been paid, the current claim will be denied.

DOM claims processing procedures were also modified to become in compliance with the 2011 Code Update AMA change in regards to the billing rules for immunization codes 90460 and 90461 on the same date.  Both codes can now be billed on a single date of service.