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CPT 90460 & 90461 for Blue Cross Healthy Families

SuperCoder Posted Thu 12th of January, 2012 16:44:12 PM

Hi Sanjit Mishra

We are getting denial for CPT 90460 & 90461 if we bill this CPT multiple times on same day for Blue Cross Healthy Families, for other blue cross & blue shield plan we are getting payments for 5 Immune Admin codes billed on same day, so is their any particular way to bill Immunization Code for Blue Cross Healty Families?
i found online that we need to bill 90460 x no.of units instead of billing 1 unit per line item for Blue Cross Healthy families is this correct way of billing? because i am not getting any help from insurance rep as they say CPT 90460 & 90461 are paid one unit per day but we are getting payments for some accounts for more than 2 Immunization Code but they are not ready to send claim back for reprocessing.

Please Help
Vinayak
Wideangleoutsourcing.com

SuperCoder Posted Fri 13th of January, 2012 21:38:25 PM

Hi Sanjit Mishra

We are getting denial for CPT 90460 & 90461 if we bill this CPT multiple times on same day for Blue Cross Healthy Families, for other blue cross & blue shield plan we are getting payments for 5 Immune Admin codes billed on same day, so is their any particular way to bill Immunization Code for Blue Cross Healty Families?
i found online that we need to bill 90460 x no.of units instead of billing 1 unit per line item for Blue Cross Healthy families is this correct way of billing? because i am not getting any help from insurance rep as they say CPT 90460 & 90461 are paid one unit per day but we are getting payments for some accounts for more than 2 Immunization Code but they are not ready to send claim back for reprocessing.

Please Help

SuperCoder Answered Sun 15th of January, 2012 14:30:48 PM

Please check the below link for BCBS guidelines and particularly the Example for the way multiple units of 90460 and 90461 is to be billed.
http://www.bcbsnc.com/content/providers/important-news/aug19-2011.htm
Revert back to me if you need further clarification.

SuperCoder Posted Mon 16th of January, 2012 18:12:14 PM

Thanks for your help

The link you provided gives the guidelines for BCBS of North Carolina , is it applicable for blue cross of CA ( Healthy Families Plan)?

Can you please clarify on this? It would be very helpful for us..

SuperCoder Answered Tue 17th of January, 2012 11:10:12 AM

Because of the high frequency of denials on this context, you may find some differences, but I think BCBS must be following as a broad guideline. Please try with a "Letter of Appeal", and let me know the result.

SuperCoder Posted Tue 17th of January, 2012 17:01:25 PM

Thank you again for your reply,
I have also spoken with one of the senior rep with BC of CA Healthy Families and even she told me the same way of billing which is showing in the link you send us. We are sending them a corrected claim and once i get any response i would surely let you know about it.

Thank you once again Sanjit this was very helpful for us.

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