Vaccine Administration Billing Changes for Health Check Providers
The Georgia Department of Community Health (DCH) has posted a new banner message for Health Check providers regarding changes in billing and payment of vaccine administration. The vaccine administration fee rate has been revised; it is now $10 for any vaccine for the Medicaid Fee for Service (FFS) population and $18.50 for any vaccine for the PeachCare for Kids population.
Georgia DCH has also opened the billing code 90460, effective March 1, 2013. Providers are to use this code going forward to bill for the vaccine administration fee. Instructions about how to use this code are in the banner message. Additionally, a new National Correct Coding Initiative (NCCI) edit has led to the requirement that providers use the '25' modifier with the Health Check visit code when they administer vaccines during the Health Check visit and bill the 90460 code.
Providers may resubmit their vaccine administration fee claims, dated January 1, 2013 or later, for reprocessing on or after March 1, 2013, in order to receive the higher reimbursement rate. If you have questions, contact HP Enterprise Services Contact Center at 770.325.9600 or 800.766.4456.
These measures lay the groundwork for the increased reimbursement that will be available under the Affordable Care Act. To view this and other Department of Community Health Banner Messages, visit: www.mmis.georgia.gov and select Provider Information from the top navigation bar.