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Mary Posted Wed 15th of January, 2014 16:12:03 PM

The code 90461 for medicaid is not working as it did. Is there a new code for this or a new modifier when used with Florida Medicaid

SuperCoder Answered Thu 16th of January, 2014 07:13:46 AM

Check with your state's medical group associations , for example - every state's got them... to see if they've got any recommendations, (or if not) to see if they're doing anything to fight the legislation, on behalf of your state's providers.

Mary Posted Fri 17th of January, 2014 18:41:57 PM

I am confused You are not answering this question. Do you mean I joined a supercoder whom is State Based.I have tried all areas before I came to you. Getting this answer is a non answer.I need to know what code including mod. in one is used for 90460/90461.Please someone help me


SuperCoder Answered Tue 21st of January, 2014 11:06:52 AM

Unfortunately, Medicaid providers are not only state-specific, but they can recommend using codes that are out of date and only the providers in the region would know if this happened. It sounds like you are using appropriate and current codes, so perhaps your carrier has changed its policy recently. Can you send us the note (with names/identifiers removed) of what you performed so we can confirm that you're using the code properly, and if so, you can appeal it with your payer?

Mary Posted Tue 21st of January, 2014 18:11:48 PM

Patient comes in for a 99394 25/ 90649, with the 90460 than 90734 would be the 90461.This is when we use it an additional administration code. All other insurances will pay Florida Medicaid rejects 90461 as incorrect modifer. So my question was is there a modifier you know of for 90461?

SuperCoder Answered Wed 22nd of January, 2014 15:35:04 PM

Is the vaccine part of the VFC program (Vaccines for Children)? If so, many Medicaid providers require the SL modifier on these.

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