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Humana 90756 and 96372

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I billed Humana 90756 for a vaccine and 96372 for the admin of the vaccine.  90756 was paid but 96372 was not.  The reason Humana gave is . . .

OE<  Payment is not allowed for these services because the procedure code was not correct for the services or date of service billed. 

151  Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

Any idea why it wasn't paid?


Is it a Medicare Advantage Plan?  If so, you need to use the cpt codes for Medicare flu shots.

It was Humana.  I reached out to them and they said...

The billed injection, 96372, was denied because it was reported with a vaccine or toxoid (90756), but without an Intramuscular (IM) or Subcutaneous (SC) injectable drug, per our policy, which is based on the AMA CPT Manual.

According to our policy, which is based on the AMA CPT Manual, a therapeutic, prophylactic or diagnostic injection should not be reported for the administration of vaccines or toxoids. 

Would it be 90471 for the admin of the flu vaccine?

 G0008  is the administration code of the flu shot for Medicare.  90471 is the administration of the flu shot for commercial carriers.


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