Home Forums Discussions Coding and Billing Coding for pediatric well visits

We're trying to figure out how to properly bill immunizations for well visits.
For example, for a 5yo who gets DPT, IPV, MMRV we code:
99393 well child age 5-11 with modifier 25
90460 for the first vaccine
90461 x7 for each additional vaccine

Is this the right way to do it?
What would a customary charge be for each of these codes?

We would appreciate any help others might offer.

I am in Florida. Medicaid has all different HMO's all requiring slightly different variations, but this is the way we do it:
For insurance patients some use a modifier for the well child cpt code (25) and some do not. For the vaccine codes the first line with the vaccine cpt is the cost of the vaccine and the second line for the vaccine is 90460 (usually we put a cost of 40.00). If the vaccine has more than one component the third line of below the vaccine will be 90461 (usually we use a charge of 40.00) and the number of units will vary.For MMRV it will be 3 units since the first unit was charged with the 90460.

Your scenario above will look like this
99393 25(modifier) 150.00Charge) 1(unit) 150.00(total charge)
90710 200.00 1 85
90460 40.00 1 40
90461 40.00 3 120
90700 35.00 1 35
90460 40.00 1 40
90461 40.00 2 80
90713 45.00 1 45
90460 40.00 1 40

In florida for straight medicaid we can only bill for the vaccine cpt code and only get reimbursed 10.00 (we have to use VFC vaccines) and we can only 90460 for which you get a few dollars(cannot bill 90461 no matter how many vaccine components)


Kinda longwinded explanation, hope it helps.

I now see that the board squished my billing example. I tried to align the other lines below the first line. there are 4 columns.
procedure code, charge, unit and total.

There's Medicaid and then there's the privates.

In Illinois, we don't use the vaccine administration codes for Medicaid. They pay administration fee based on the vaccine code.

The official way is based on components. Thus, DTaP (and TDaP, MMR) is 1 x 90460 and 2 x 90461. MMRV is as above 1 x 90460 and 3 x 90461

As was stated above, sometimes you need a 25 modifier on, and sometimes you don't.