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As a result of a Q4 2025 edit release, some providers may have had 90480 claims denied when billed in conjunction with G0008, G0009, or G0010. On Oct 14, CMS issued replacement files to remove this edit.
What’s Changed
CMS rescinded the edit that flagged vaccine administration codes billed on same date of service.
- Pharmacies no longer need to use modifier 59 when administering a COVID vaccine on the same date as other Medicare Part B vaccines.
- Per CMS, Medicare Administrative Contractors (MACs) are instructed to automatically reprocess impacted claims.
- A provider may choose to use the MAC appeals process if they don’t wish to wait for the expected automatic adjustment to occur.
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More info: MLN Connects Newsletter for October 15, 2025 | CMS
Claim Holds & Payment Timing
- CMS initially instructed MACs to hold claims dated Oct 1, 2025 and later.
- CMS reminded providers that all Part B claims are held for a minimum of 14 days, which may impact payment timing even when claims are submitted correctly.
Moving Forward
- Modifier 59 is no longer needed when billing COVID vaccine administration with other Part B vaccines.
- Monitor claim payments closely, especially for previously denied or delayed claims.
- Use the MAC appeals process for missing payments or unexpected denials.
- Continue to verify Medicare Part B coverage and eligibility.
- Reference the CMS Part B vaccine and pricing list to confirm the following:
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