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GARDASIL FOR OVER AGE OF 26

Michelle Posted Thu 28th of February, 2019 09:20:19 AM
I have a patient who is 29 years old and got the vaccine, not all insurances have changed their guidelines for people over age 26 to get the vaccine. The patient's insurance denied the claim and said that there is a modifier that we can add to CPT code 90651 that should be filed on the claim. Does anyone know what modifier that is? The patient signed a general waiver of liability if insurance denied, but if there is a modifier that I should be using based on her age I want to know what it is. Thank you
SuperCoder Answered Fri 01st of March, 2019 09:05:04 AM

Hi,

Thanks for your question.

If you are billing code 90651 with E/M code then you have to add modifier 25 with the E/M code. For better understanding of the denial and give you appropriate answer, please send us the EOB document received from the insurance regarding the denial.

Please send the document on customerservice@supercoder.com.

Thanks.

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