One of the nation's largest insurers is piggybacking on new restrictions that complicate physicians getting paid for performing vaccinations.
UnitedHealthcare (UHC) announced in its July 2013 Network Bulletin that it will align with Correct Coding Initiative (CCI) edits that went into effect Jan. 1, 2013. These changes, detailed in a February blog, affect evaluation and management (E/M) services and immunization administration codes.
UHC said that beginning in the third quarter of 2013 it will deny Current Procedural Terminology (CPT) codes 99201-99380 and 99401-99499 when reported on the same date of service as an immunization administration service (CPT codes 90460-90461 and 90471-90474). However, if the E/M code is reported with modifier 25, indicating it is a significant and separately identifiable service provided on the same day, UHC will pay for both codes. On the plus side, this policy change will not apply to preventive medicine E/M services (CPT codes 99381-99397 and Healthcare Common Procedure Coding System code G0402), which is often the type of E/M service during which vaccines are administered.
No word yet on what other payers may also be following suit, but it’s a safe bet that UHC is not alone and will not be the last.
– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians
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