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Thursday, February 14, 2013

CMS providing some help on vaccine-related E/M coding change

The Centers for Medicare & Medicaid Services (CMS) is providing some limited relief to physicians dealing with recent changes to how they're paid for vaccinations.

As this blog covered previously, the Jan. 1 round of Correct Coding Initiative (CCI) edits required that providers append modifier 25 to evaluation and management (E/M) services performed in connection with immunization administration services (90460-90474) provided on the same date to the same patient or only get paid for the immunization administration.

Subsequent to that post, I learned that CMS sent an alert on Feb. 1 to all state Medicaid agencies. The alert allows each state to deactivate the edits as they pertain to preventive medicine service codes (99381-99397) and immunization administration codes, retroactive to Jan. 1.

The deactivation is only applicable for the first quarter (Jan. 1-March 31, 2013). It's also up to each individual state Medicaid agency, and each state that does deactivate the applicable edits will have to individually decide whether to reprocess Medicaid claims already submitted since the beginning of the year.

CMS said it expects that state Medicaid agencies that choose to retain the edits will educate physicians on the proper E/M coding and use of modifier 25 to bypass the edits.

CMS has not made any unilateral decisions to deactivate these CCI edits nationally at this time, so outside of Medicaid in those states that choose to deactivate them, the new edits remain a hassle.

Still, some relief is better than none, and the American Academy of Family Physicians and other medical societies are continuing to ask CMS to rescind the edits at all levels.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.

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