I am not a coder/biller. Let’s get that out of the way right now.
HOWEVER - for those that do Vaacines/VFC - how do you bill your vaccines? It’s my understanding that even for VFC you bill an admin fee, as well as the code for the vax/components but at zero dollars. I cannot add a code with price options (obviously) so how do you bill those codes for VFC vs private?
Check your state VFC program! I believe most states cover the vaccine admin codes 90460 and 90461. Yes should be billing these - you're losing out on a lot of money if you're not!
What do you mean you can't add codes with price options? Like in AC? Yes you can. But for us, we don't add the vaccine and vaccine admin codes in AC. We have a paper superbill and the billing person adds them in the PM software. The doctor selects the E&M code in AC only and that goes over to the PM software automatically. Just better workflow this way.
I should clarify - I’d like to add the vaccine code bit with private pay option and also a zero dollar option - we use VaxCare so they bill the private insurance for us, but the VFC we can’t have duplicates for two different price points.
They hadn’t billed admin fees for over 3 years. I’m trying not to vomit thinking about how much money we’ve missed out on.
They weren’t billing for like…..anything. It’s pure insanity. It is not a comfortable subject for me, I’m not super familiar with billing.
I don’t even know what we’re missing - because they are using a horrible billing company. It’s super frustrating.
So do you do in house billing or use an outside company?
You can just bill the VFC vaccines with the amount you bill private ins. Medicaid will pay $0 and then you adjust the rest. For vaccine admin, you should bill medicaid and private ins the same amount anyway. Medicaid will pay their rate and again you just adjust the rest as usual. For self pay you can charge the patient the vaccine admin fee. Check with your state VFC program - there is probably a max. amount you're allowed to charge. Texas is $13.75 so we charge $13.
If you do well child checks there are many other codes you can bill if you do them - like hearing screen, vision screen, depression screen, developmental screen. Texas medicaid requires all of these for well checks anyway so we have to do them for everyone. Each is not a big amount but they do add up. If you check the Bright Futures periodicity schedule you can see all the screenings that are recommended at each age. ACA plans (which is most ins plans nowadays) have to follow Bright Futures and have to cover all these screenings as preventive, i.e., no patient costshare.
Serene Office Manager General Pediatrics Houston, Texas
I do not know how Medicaid works in your state, but in Florida you have to bill for the vaccine, and 90460 only. If three vaccines were given, you bill for each vaccine seperately and one 90460 code with 3 units. You will receive 0 for each vaccine and $30 for the 90460 (with 3 units). If you are billing for private vaccines you bill for each vaccine seperate(the cost) and 90460(for the first vaccine component) and 90461( one unit for each additional vaccine component).
To determine the vaccine components for private vaccine billing there is coding sheet.
--------------------------------------------------- Raj From (mostly) sunny Port St Lucie, florida
Yes you're right. Medicaid doesn't cover 90461, only private ins. Some states, including TX, used to pay for it but that has changed in recent years because of some national VFC policy I think.
Serene Office Manager General Pediatrics Houston, Texas
Much to my dismay and hopefully soon to be different - the providers codes and then sends to a billing company. I’m attempting to standardize all of our WCC to Iowa’s Periodicity. I’m getting there! Thanks for the tips!
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