Home Forums Discussions Problems Bug in 6.5.6 re CPT multiplier

When a patient gets multiple immunizations, we bill a multiple of the fee for immunization administration. If the kid gets 3 shots, we bill 3 times the fee for giving each shot (eg 90460). If 90460 is $1, then the fee for 3 shots would be $3.

In 6.5.6:
--CMS 1500 is correct
--Invoice does the correct arithmetic ($3 in the example above), but LEAVES OUT THE MULTIPLIER. It just says: 90460...$3.

Problem is this: I send the invoice to my billing service. They bill insurer. Biller enters the amount (correct) but there is no multiplier. The insurer's computer assumes that only 1 unit of 90460 was given, so no matter what I bill for, they pay me only what they pay for 1. This is a big issue with a lot of money involved. In the example above, the insurer may pay $1 for 90460. They will pay me $1. They won't pay $3 if they don't know I gave 3 shots.

My only fix is to print the invoices on paper, recall how many of each CPT, and write it in by hand. Yes, this is a problem.

Wolffe Nadoolman MD

Wow, that's even worse than before. AC still will not let you put the same CPT code in multiple lines rather forces you to use "units". I do a lot of injections and all of my payors will not recognize "units" for CPT codes other than J codes (which are medications). They will only pay if you enter the code multiple times. I have complained to AC about this and they told me it wasn't a priority to fix that, even when they were working on a PM program. This is one reason why I will not use a link to a PM because with my practice it would be worthless. I do 5 ligament injections and when it goes to the insurance company it looks like I did one injection at the cost of 5.

Did you file a bug report. I believe they are aware of the problem, but there is strength in numbers. The more times it is reported, the more seriously they will take it.

Having said that. on my 6.5.6, it puts a 60460 for each immunization. This may have been by design because, I believe, TX medicaid (and perhaps others) require it to be that way, and someone requested it. Are your payors ignoring the multiple instances since the multiplier is not in effect.

To my knowledge, billing for immunizations has not been fixed yet. I would guess this is due to a variety of interpretations on how it should be done.