I have a handout from one of my insurers that says the following as an example:
MMR 90460
DTaP
Pneumo 90461 x 2
another visit...
RV 90460
DTAP-Hib-IPV 90461 x 1
It looks like they only want to pay for 1 unit of 90461 with each additional SHOT, but I thought it was originally for each add component.
IF YOU READ THIS EARLIER, IT HAS CHANGED
I just received this from the Illinois Chapter of the AAP
"The American Academy of Pediatrics (AAP) has been in contact with Blue Cross Blue Shield (BCBS) of Illinois on its claims processing for immunization administration. To facilitate payment and reduce claim denials as duplicates, when submitting claims to BCBS of IL for immunization administration using codes 90460 (immunization administration, first component) and 90461 (each additional component) for multiple vaccines and/or multiple components, you must report the code(s) in units and not per line item. By submitting per line item, claims are unable to be adjudicated appropriately. For example, if you administer a Pentacel (DTaP-Hib-IPV), Hepatitis B and a Pneumococcal, you should report 90460 with 3 units and 90461 with 4 units in addition to the appropriate vaccine product codes."
THUS They should be combined but not in the way I stated above. I just learned something.
