Prepare now for a handful of changes coming to the way you code for influenza vaccinations in 2014. Getting paid successfully, however, may require you to hold onto some claims for longer than you would ordinarily like.
CMS has directed the Medicare Administrative Contractors (MACs) to pay for flu vaccine code 90673 beginning with dates of service of Jan. 1, 2014 or later. Here’s the catch. When the claim is processed prior to April 7, 2014, payment is to be based on “local pricing guidelines,” according to the transmittal.
The agency has not yet set a payment limit amount for this code, though that is expected in early 2014. When your claim is processed on or after April 7, 2014, payment will be based on that national payment amount.
As is usually the case with influenza vaccine codes coinsurance and deductible do not apply to these services.
These codes are being removed from the Medicare Claims Processing Manual for influenza vaccination, with the effective date backdated to July 1, 2013: 90658, Q2034, Q2035, Q2036, Q2037, Q2038 and Q2039. CMS has not confirmed that it will no longer pay for these codes, though it’s advisable for you to avoid using them whenever possible.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:
Quality of ...
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...