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Vaccine Coding for Hib 90646

Lisa Posted Thu 20th of October, 2011 20:23:22 PM

Does anyone know of any new codes for HIB prp-d. I am getting denials from insurance company that has removed the code from their fee schedule

SuperCoder Answered Fri 21st of October, 2011 02:39:17 AM

Denials of CPT 90646: In the absence of injury or direct exposure, preventative immunizations (vaccination or inoculation) against such diseases as Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster will not be not covered.
In cases where a vaccination or inoculation is excluded from coverage, the entire charge will be denied (such as office visits, which were primarily for the purpose of administering a non-covered injection).
*
This can be well-observed from the list of diagnosis codes that Medicare reimburses in such scenario are only ICD codes for injury and wound.
Are you also getting denials from commercial ones?

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