1206 bulletin

Attention: All Providers

2007 Checkwrite Schedule

Beginning February 2007, the cutoff day for electronic claims submission will change from Friday to Thursday due to anticipated increased processing time for the National Provider Identifier (NPI) implementation. It is important that you make any required system changes to accommodate this cutoff day. Following is the 2007 checkwrite schedule:

Month	Electronic Cut-Off	Checkwrite Date
January	01/05/07	01/09/07
	01/12/07	01/17/07
	01/19/07	01/25/07
February	02/02/07	02/06/07
	02/08/07	02/13/07
	02/15/07	02/20/07
	02/22/07	02/28/07
March	03/01/07	03/06/07
	03/08/07	03/13/07
	03/15/07	03/20/07
	03/22/07	03/29/07
April	04/05/07	04/10/07
	04/12/07	04/17/07
	04/19/07	04/26/07
May	05/03/07	05/08/07
	05/10/07	05/15/07
	05/17/07	05/22/07
	05/24/07	05/31/07
June	05/31/07	06/05/07
	06/07/07	06/12/07
	06/14/07	06/21/07

Month	Electronic Cut-Off	Checkwrite Date
July	06/28/07	07/03/07
	07/05/07	07/10/07
	07/12/07	07/17/07
	07/19/07	07/26/07
August	08/02/07	08/07/07
	08/09/07	08/14/07
	08/16/07	08/23/07
September	08/30/07	09/05/07
	09/06/07	09/11/07
	09/13/07	09/18/07
	09/20/07	09/27/07
October	10/04/07	10/09/07
	10/11/07	10/16/07
	10/18/07	10/23/07
	10/25/07	10/31/07
November	11/01/07	11/06/07
	11/08/07	11/14/07
	11/15/07	11/21/07
December	11/29/07	12/04/07
	12/06/07	12/11/07
	12/13/07	12/20/07

EDS, 1-800-688-6696 or 919-851-8888

Attention: All Providers

Clinical Coverage Policies

The following new or amended clinical coverage policies are now available on the Division of Medical Assistance’s Web site at http://www.ncdhhs.gov/dma/mp/mpindex.htm:

Endovascular Repair of Aortic Aneurysm, #1A21

Kidney Transplantation, #11B4

Liver Transplantation, #11B5

These policies supersede previously published policies and procedures. Providers may contact EDS at 1-800-688-6696 or 919-851-8888 with billing questions.

Additionally, all policies have been revised this month to supply additional information related to Early and Periodic Screening, Diagnosis and Testing (EPSDT) for recipients under the age of 21.

Clinical Policy

DMA, 919-855-4260

Attention: All Providers

CPT Codes 90467, 90468, 90473 and 90474—Coverage of Immunization Administration Codes for Oral/Intranasal Vaccines

Effective with date of service August 1, 2006, the N.C. Medicaid program covers CPT codes for the intranasal and oral administration of vaccines/toxoids. Their code descriptors are as follows:

90467- Immunization administration under 8 years of age (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid) per day. (For N.C. Medicaid, do not report in addition to 90465.)

90468- Each additional administration (single or combination vaccine/toxoid) per day (list separately in addition to code for primary procedure). (For N.C. Medicaid, use 90468 in conjunction with 90465.)

90473- Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid). (For N.C. Medicaid, do not report in addition to 90471.)

90474- Each additional vaccine (single or combination vaccine/toxoid). (List separately in addition to code for primary procedure.) (For N.C. Medicaid, use 90474 in conjunction with 90471.)

The current codes used for immunization administration and their descriptors are as follows:

90465- Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid) per day. (For N.C. Medicaid, do not report 90465 in conjunction with 90467.)

90466- Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid) per day. (List separately in addition to code for primary procedure.) (For N.C. Medicaid, use in conjunction with 90465 or 90467.)

90471- Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid). (For N.C. Medicaid, do not report 90471 in conjunction with 90473.)

90472- Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid) each additional vaccine (single or combination vaccine/toxoid). (List separately in addition to code for primary procedure.) (For N.C. Medicaid, use 90472 in conjunction with 90471.)

The following principles should guide the billing of the six codes described above:

1. Apply the appropriate code depending on the age of the recipient and whether or not the physician has counseled the recipient and family.

2. CPT codes 90465 and 90466 are in the same code family, and 90471 and 90472 are in the same code family. A code from one injectable code family cannot be used with a code from another injectable code family.

3. CPT codes 90467 and 90468 are in one code family and 90473 and 90474 are in another code family. A code from one intranasal/oral code family cannot be used with a code from the other intranasal/oral code family.

4. The physician counseling codes should not be used as an “add-on” counseling code to the other administration codes.

5. Physicians, nurse practitioners and physician assistants may perform these services.

6. When billing 90465, 90466, 90467 or 90468, the physician, nurse practitioner, or physician assistant must perform face-to-face vaccine counseling associated with the administration and should document such. The physician, nurse practitioner, or physician assistant is not required to administer the vaccine.

7. A “first” administration is defined as the first vaccine administered to a recipient during a single patient encounter.

8. At the present time, there should not be an occasion to bill a second intranasal/oral vaccine administration code.

9. When billing one or more injectable vaccines along with one oral/intranasal vaccine, the code for the first injectable vaccine is the primary code.

Billing Guideline Examples for Immunizations for Recipients Birth through Age 20

Vaccine: Injectable Provider Type: Private Sector Providers
Service Type	With Physician Counseling	Without Physician Counseling
Health Check Screening with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two or more vaccines, bill 90465EP with 90466EP. Report vaccine CPT codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine bill 90471EP. Report vaccine CPT code. For two or more vaccines bill 90471EP and 90472EP. Report vaccine CPT codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Immunization(s) Only	For one vaccine, bill 90465EP. Report vaccine CPT code. For two or more vaccines, bill 90465EP and 90466EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) not required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two or more vaccines, bill 90471EP and 90472EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) not required.
Office Visit with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two or more vaccines, bill 90465EP and 90466EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two or more vaccines, bill 90471EP and 90472EP. Report CPT codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Core Visit with Immunization(s)	N/A	N/A

Vaccine: Injectable Provider Type: FQHC/RHC
Service Type	With Physician Counseling	Without Physician Counseling
Health Check Screening with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two vaccines or more, bill 90465EP and 90466EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two vaccines or more, bill 90471EP and 90472EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Immunization(s) Only	For one vaccine, bill 90465EP. Report vaccine CPT code. For two vaccines or more, bill 90465EP and 90466EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) is not required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two vaccines or more, bill 90465EP and 90466EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) is not required.
Office Visit with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two vaccines or more, bill 90465EP and 90466EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two vaccines or more, bill 90471EP and 90472EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Core Visit with Immunization(s)	Cannot bill 90465EP or 90466EP. Immunization diagnosis code(s) are not required. Immunization procedure code(s) are required.	Cannot bill 90471EP or 90472EP. Immunization diagnosis code(s) are not required. Immunization procedure code(s) are required.
Vaccine: Injectable Provider Type: Local Health Departments
Service Type	With Physician Counseling	Without Physician Counseling
Health Check Screening with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two or more vaccines, bill 90465EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine, bill 90471EP. Report vaccine CPT code. For two or more vaccines, bill 90471EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Immunization(s) Only	For one vaccine, bill 90465EP. For two vaccines or more, bill 90465EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) not required.	For one vaccine, bill 90471EP. For two vaccines or more, bill 90471EP. Report CPT vaccine codes. One immunization diagnosis code is required. Immunization procedure code(s) not required.
Office Visit with Immunization(s)	For one vaccine, bill 90465EP. Report vaccine CPT code. For two or more vaccines, bill 90465EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.	For one vaccine, bill 904671EP. Report vaccine CPT code. For two or more vaccines, bill 90471EP. Report CPT vaccine codes. Immunization diagnosis code(s) not required. Immunization procedure code(s) are required.
Core Visit with Immunization(s)	N/A	N/A

Vaccine: Intranasal/Oral Provider Type: Private Sector Providers
Service Type	With Physician Counseling	Without Physician Counseling
Health Check Screening with Immunization(s)	For one vaccine, bill 90467EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is not required. Immunization procedure code is required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is not required. Immunization procedure code is required.
Immunization(s) Only	For one vaccine, bill 90467EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is required. Immunization procedure code is not required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is required. Immunization procedure code is not required.
Office Visit with Immunization(s)	For one vaccine, bill 90467EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is not required. Immunization procedure code is required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two or more vaccines – N/A Immunization diagnosis code is not required. Immunization procedure code is required.
Core Visit with Immunization(s)	N/A	N/A

Vaccine: Intranasal/Oral Provider Type: Local Health Departments
Service Type	With Physician Counseling	Without Physician Counseling
Health Check Screening with Immunization(s)	For one vaccine, bill 90467EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code is not required. Immunization procedure code is required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code(s) not required. Immunization procedure code is required.
Immunization(s) Only	For one vaccine, bill 90467EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code is required. Immunization procedure code is not required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code is required. Immunization procedure code is not required.
Office Visit with Immunization(s)	For one vaccine, bill 90467EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code not required. Immunization procedure code is required.	For one vaccine, bill 90473EP. Report vaccine CPT code. Two vaccines or more – N/A. Immunization diagnosis code not required. Immunization procedure code is required.
Core Visit With Immunization(s)	N/A	N/A

Vaccine: Injectable with Intranasal/Oral

Provider Type: Private Sector Providers

Service Type

With Physician Counseling