Is your practice feeling financial strain due to rising vaccine costs and inadequate reimbursement rates? Jamie Loehr, MD, past American Academy of Family Physicians liaison to the CDC’s Advisory Committee on Immunization Practices, offers some suggestions on minimizing immunization costs while maximizing reimbursement.
Use CPT codes 90460 and 90461 for pediatric patients. In addition to the Current Procedural Terminology (CPT) codes for the individual vaccine and appropriate diagnosis, a related vaccine administration code must be applied for reimbursement. CPT codes 90460 and 90461 should be used exclusively for patients ages 18 years or younger. These CPT codes can be used to bill for individual vaccine components when a physician provides face-to-face counseling.
Because CPT counseling codes pay per component, there is the opportunity for substantially higher reimbursement, Loehr says. For example, the three components of the measles, mumps, and rubella vaccine can be billed individually (the first using 90460 and the remaining two using 90461). Without counseling, the single CPT code 90471 should be used. Therefore, it is worth taking time to provide this counseling rather than asking staff to administer the vaccine, Loehr explains. (In adult patients, however, there is no opportunity to bill for individual components of a multiple-antigen vaccine.)
“If clinicians don’t know about this rule, they are leaving a lot of money on the table,” he says.
Research vaccine costs. “Buying directly from the manufacturer or vaccine groups is an effective way to get the best prices,” Loehr says.
Return expired vaccines for a refund. Clinicians are often unaware that it is possible to return expired vaccines, Loehr says.
Enlist staff to encourage immunizations. Nurses and other staff can say to patients: “You’re due for a flu vaccine. Would you like to get it today?”
American Academy of Pediatrics Immunizations: Ordering, Financing, and Maintaining Supply www.aap.org
American Academy of Family Physicians Coding for Vaccine Administration www.aafp.org
Immunization Action Coalition Financial Considerations www.immunize.org
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