Recent changes to vaccine coding physicians need to know

August 25, 2017

A Medicare change may effect billing

Q: We have had 90682 denied when we bill it to Medicare, but we thought it went into effect January 2017. Is this correct?

A: A recent Change Request (CR) 9876 gave instructions regarding how Medicare is going to pay for this code.  

90682  Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

There is a six-month implementation period, so 90682 will be paid for dates of service (DOS) on or after July 1, 2017. However, your local Medicare Administrative Contractor (MAC) will pay at its discretion for DOS between July 1, 2017, and July 31, 2017.  Annual Part B deductible and coinsurance amounts do not apply to this code.

MACs will deny Part B claims submitted with code 90682 for dates of service January 1, 2017, through June 30, 2017, using the following messages:

Claim adjustment reason code: 181
“Procedure code was invalid on the date of service.”

Remittance advice remark code: N56
“Procedure code billed is not correct/valid for the services billed or the date of service billed.”

Group code: CO
(Contractual Obligation)

The following vaccine codes are effective July 1, 2017. Check with your local MAC to see if they are paying for these codes July 1, 2017, through July 31, 2017. 

Renee Dowling is a billing and coding consultant with VEI Consulting in Indianapolis, Indiana. Send your coding questions to medec@ubm.com.