[Ohioaap-practicemanagers] UnitedHealthcare Community Plan of Ohio Vaccine Billing Change

[Melanie Farkas]

Sharing an article we are sharing with our membership:

Coding Update: UnitedHealthcare Community Plan of Ohio Vaccine Billing Change

Recently, many Ohio AAP members were confused about a recent letter from UHC Community Plan of Ohio.

The Ohio AAP approached ODM last year with concerns that the managed care plans were not using uniform billing for vaccinations. After that discussion, all of the managed care plans except UHC decided to align with the fee-for-service vaccine billing policy.

This recent alert on CPT code 90460 for VFC vaccines from UHC now means that they are aligning with the fee-for-service vaccine billing policy as of September 1, 2017. The Ohio AAP’s billing & coding experts wanted to share that it is important for practices to list 90460 on multiple detail lines. It does not appear that they will accept 90460 time X number of units.

The letter is also a reminder of ODM’s policy change effective Jan. 1, 2016 <http://ohioaap.org/wp-content/uploads/2017/05/MAL-604.pdf> to no longer use code 90461. That code was was used for the reporting of the different toxoid components that make up a combination vaccine but ODM instead pays for each administration of a VFC vaccine toxoid code.

If you have additional questions on billing and coding for claims payments, you should follow up with UHC’s Provider Services at 1-800-600-9007.

The Ohio AAP offers its thanks to those who contacted us to help clarify this issue!


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