Medical Billing Forum

Coding => Coding => : Asheldon13 April 02, 2013, 11:03:11 AM

: Coding Adminstration
: Asheldon13 April 02, 2013, 11:03:11 AM

Good Morning All:
Happy Spring!  We are getting there.
Does anyone know how we can bill Medicare for the administration only of Zostavax?
I read about a HCPC code G0377 that was for the administration of vaccine for Part D with
the appropriate dx code.  But I don't think that the code is valid any longer.

Thanks in advance for your help.
Anna

: Re: Coding Adminstration
: RichardP April 02, 2013, 03:00:25 PM

We code 90736 for the vaccine and 96372 for the subcutaneous injection.  Medicare will not pay for the vaccine, but we can bill the patient for same after we have first billed Medicare and they have declined to pay.  Note that you must bill Medicare and get a rejection before you can bill the patient.  This would be a situation where you should use an ABN with the patient.

: Re: Coding Adminstration
: Asheldon13 April 02, 2013, 03:08:41 PM

Hi Rich:
Has Medicare actually paid for the administration (90736)?
Thank you so much.
Anna

: Re: Coding Adminstration
: RichardP April 02, 2013, 07:03:40 PM

: RichardP  April 02, 2013, 03:00:25 PM

We code 90736 for the vaccine and 96372 for the subcutaneous injection [administration of vaccine].

Medicare does not pay for either the vaccine or the administration - since Zostavax is considered preventative/preventive.  All of my clients charge the patient for the vaccine, after Medicare has denied coverage.  Some also charge for the administration, some do not.

: Re: Coding Adminstration
: Asheldon13 April 03, 2013, 01:28:15 PM

Thank you so much.
Anna