Check flu vaccine codes to avoid claim denials
If you are receiving denials on your Medicare claims for influenza vaccinations this season, it may be due to inadvertent coding errors.
Medicare administrative contractors (MACs) are reporting many flu vaccine claims being billed with the incorrect National Drug Codes (NDC) or CPT codes. The NDCs change every flu season, and each box of vaccines includes the NDC assigned by the manufacturer. You must include the NDC on the claim, either in Loop 2410 LIN segments of the electronic claim or on Item 19 of the CMS-1500 paper claim. You must bill the correct NDC and HCPCS code for the influenza vaccine for your claim to process. MACs will deny incorrectly billed claims.
Review the CMS Seasonal Influenza Vaccines Pricing web page and use the appropriate flu vaccine codes to avoid processing delays and claim denials.
— Kent Moore, Senior Strategist for Physician Payment, American Academy of Family Physicians
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Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.