tci Medicare Compliance & Reimbursement - 2016 Issue 7

Reader Question: Vaccines May Not Comprise Just One Code

Question: Do flu vaccines always require two codes? Answer: Yes, according to Humana. “In order to help ensure correct billing and payment, two codes are needed for each vaccination claim: one administrative code and one vaccine code,” the payer says. You’ll report a flu vaccine administration code (such as 90460-90474) and another code for the vaccine itself, such as 90630 (Influenza virus vaccine, quadrivalent [IIV4], split virus, preservative free, for intradermal use), 90653 (Influenza vaccine, inactivated [IIV], subunit, adjuvanted, for intramuscular use), or another appropriate code that describes the material injected. Therefore, if you administer a...

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