Highmark BCBS: reimbursement for vaccines – under 19 years old

Are you a NY provider that administers vaccines for patients under 19 years old? Then this blog post is for you!

Ensure proper billing is followed:

  • Even if the vaccines are received through the VFC program, the providers still need to report the administered vaccine serum
  • Vaccine administration code and any applicable modifiers

Reporting/HEDIS:

  • The proper medical billing and coding for VFC administered vaccines ensure that the claims are used for reporting HEDIS and
  • Help reflect the quality of care that is delivered for the members/patients

Reimbursement:

  • Highmark BCBS does reimburse for the administration of the vaccines- unless otherwise specified by CMS, state, federal or the provider.

Balance Billing Reminder:

  • Any Highmark BCBS provider is not allowed to balance billing the patient

Coding administrative codes for when the counseling was not performed

  • vaccine administration codes under 19 years old 90471: First injectable vaccine or toxoid administered (percutaneous, subcutaneous, or intramuscular).
    90472: Add-on code for each additional injectable vaccine given at the same visit.
    90473: First intranasal or oral vaccine or toxoid administered.
    90474: Add-on code for each additional intranasal or oral vaccine administered at the same visit.

Coding for administratiin codes when the counseling has been performed:

  • 90460: Reported for the first component of each vaccine or toxoid administered.
    90461: Add-on code reported for each additional vaccine or toxoid component administered in the same shot.

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