Medicaid
Found in GAMMIS Provider Messages on 2/19/24: Health Check Reimbursement for RSV Vaccine Administration
Reimbursement for Respiratory Syncytial Virus (RSV) Vaccine Administration
To address provider concerns related to the increased number of RSV cases and maternal RSV vaccination, the Department of Community Health (DCH) is allowing reimbursement for the administration of RSV vaccines. RSV vaccines protect infants and babies from becoming sicker from the virus. The two RSV vaccines, BeyfortusTM and Abrysvo, are available to Health Check providers via the Vaccines For Children (VFC) program. Reimbursement is also allowed on claims submitted for members 19 through 20 years of age.
Beyfortus
DCH allows reimbursement for new RSV vaccine administration codes 96380 and 96381 under the Health Check Program (COS 600). These new vaccine administration codes are covered for the administration of BeyfortusTM RSV monoclonal antibody vaccine and replaces the previously instructed generic CPT code 96372. For claims beginning with date of service March 1, 2024, Health Check providers should no longer report 96372 for the administration of BeyfortusTM. Providers should report the new vaccine administration codes (96380 or 96381) with the EP modifier, along with the BeyfortusTM vaccine product codes (90380 or 90381) with the EP modifier.
Abrysvo
DCH allows reimbursement for the administration of the Abrysvo vaccine under the Health Check Program (COS 600). For claims beginning with date of service January 1, 2024, Health Check providers should code the Abrysvo product (CPT code 90678) with the EP modifier. Additionally, the Abrysvo product should be reported with the appropriate vaccine administration code (90460, 90471, 90472) with the EP modifier.
Health Check Reimbursement for E&M Codes and Preventative Visits
Provider Messages (georgia.gov)
Effective 01/01/2024, Health Check Providers may report E/M codes 99202-99205, 99213-99215, in addition to E/M codes 99211 and 99212, when also reporting a preventive visit for Medicaid-eligible and PeachCare for Kids® (PCK)-eligible children. Health Check Providers should report the preventive visit with CPT codes 99381-99385, 99391-99395. If an abnormality is encountered or a preexisting problem is addressed during the preventive visit, and if the problem/abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99202-99205, 99211-99215 should also be reported.
Save the Date for the Spring Medicaid Fair
March 21, 2024 - Macon Marriot City Center in Macon, GA.
- The Spring Medicaid fair is the same day as the KHF Practice Administrator meeting with a speaker presenting. If possible, practices may want to send a billing representative to the Medicaid meeting to allow the PA to attend the KHF PA meeting.
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