Reimbursement guidelines for NGS Medicare Part - B; CPT® code G0008 & 90686

Hi,

This is in regards to the CPT® code G0008 and 90686 are getting denied as care covered another payer and the office visits are paid on the same claim. Only the Vaccine admin code and the flu vaccine codes are getting denied as care covered by another payor. We reached Medicare and Medicare stated that the CPT® codes G0008 and 90686 are payable only by Part-A carrier and not by Part - B. So the claims are getting denied as care covered by another payer.

Kindly suggest me a possible way for reimbursement on the claim. Thank you for your consideration.

Regards,

Hari

re: Reimbursement guidelines for NGS Medicare Part - B; CPT® code G0008 & 90686

Part A is hospital only which doesn't make sense for a flu shot. This leads me to believe that the patient is in a skilled nursing facility. Did the pt come from a SNF? If so, then there are only certain things that Medicare will pay the Dr for and I believe it's only services that CANNOT be done at the SNF. If this is the case, then Medicare is saying that the pt could have got the flu shot at the SNF. Hope this helps, but this is the only thing that makes sense to me.

re: Reimbursement guidelines for NGS Medicare Part - B; CPT® code G0008 & 90686

Thank you so much for sharing the information. We have billed the services under the place of service 22 (Outpatient) and the flu vaccines are payable only in the Place of service 11 (office). So Can we correct the place of service to 11 (office) and resubmit the claim to Medicare.

re: Reimbursement guidelines for NGS Medicare Part - B; CPT® code G0008 & 90686

With what POS do you normally bill? If you are an outpatient facility, then you cannot change the POS to office just to get the claim paid.