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2013 Immunization Reimbursement Workshop. August 1, 2013. Reimbursement Guidelines. Immunizations and Administrations are covered under the Preventive Care Services Benefits Each member’s benefits are defined by: Commercial: The benefit plan selected by the members employer
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2013 Immunization Reimbursement Workshop August 1, 2013
Reimbursement Guidelines • Immunizations and Administrations are covered under the • Preventive Care Services Benefits • Each member’s benefits are defined by: • Commercial: The benefit plan selected by the members employer • Medicaid: The benefit plan as outlined by the State of Rhode Island • Medicare: The benefit plan as outlined by CMS and chosen by the member • The standard UHC Certificate of Coverage covers Preventive Care including immunizations administered in a physician’s office • Some immunizations are excluded from coverage, such as immunizations required for travel, employment, education, marriage, etc.
Vaccines • A vast number of vaccinations administered to our Rhode Island members are State supplied through the State of Rhode Island • State Supplied vaccines should be billed using the appropriate CPT/HCPS code • UHC will reimburse the State Supplied vaccine: • State Supplied - $.50 • Non State Supplied – The applicable fee schedule
Administration Codes • Administrations codes (as of 1/1/2011): • 90460 – Immunization administration w/physician counselling; first vaccine/toxoid component • 90461 – Immunization administration w/physician counselling; each additional vaccine/toxoid component • 90471 – Immunization administration w/out physician counselling; first vaccine/toxoid component • 90472 – Immunization administration w/out physician counselling; each additional vaccine/toxoid component
Immunization Administration Policy • Administration: 90460, 90461, 90471, 90472, 90473, 90474, G0008*, G0009*, G0010, G9141* • Hepatitis A: 90632, 90633, 90634, 90636 • Hemophilus Influenza B: 90645, 90646, 90647, 90648 • HPV: 90649, 90650 • Influenza Virus: 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, Q2035, Q2036, Q2037, Q2038, Q2039 • Pneumococcal Conjugate: 90669, 90670, S0195 • Rotavirus: 90680, 90681 • Dtap/Dtpap-IPV, Dtap-Hib-IPV/DTP/DT/Tetanus/Polio/TdaP/Measles, Mumps, Rubella/MMR: 90696, 90698, 90700, 90701, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90713, 90714, 90715, 90718, 90719, 90720, 90721, 90723 • Varicella: 90716 • Pneumococcal: 90732 • Meningococcal: 90733, 90734 • Zoster: 90736 • Hepatitis B: 90740, 90743, 90744, 90746, 90747, 90748 • * Admin Codes for Medicare Flu Vaccines
