Guest guest Posted October 29, 2011 Report Share Posted October 29, 2011 Hi , For MA administration fee reimburse rate in your geographic area, you can go to www.cms.gov --> Medicare --> Physician fee schedule look up, the web site is: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx Typically, for the first vaccination of the visit, CPT code is 90471, each following is 90472. Most time, it doesn't matter which vaccine. Of cource you charge the CPT code for the vaccination you give. Insurances reimburse rate varies: roughly $10 - 30. The exception is Flu shot this year. Medicare listed different flu shots with different administraion fee. For example: One of the Flu vaccines: CPT Q2036, Admin: G0008. Your friend can charge whar ever he wants, but Medicare and insurances have their contract fee. Unless out of network, and his patients are willing to pay. How this is helpful. Wen LiangSan Mateo, CA ,Do you participate with insurance? There are codes for that. Generally my 90471 charge which is injection of a single antigen vaccine in adults is $25 and I get paid anywhere from $9 to $25 for it. There are different codes for babies and younger kids which have a higher charge associated with it because of “counseling”. All the prices from your friend sound high. But don’t forget the administration fee includes storage, VIS sheet production, documentation costs, etc. Kathy Saradarian, MDBranchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Friday, October 28, 2011 10:16 PMTo: Subject: vaccine fees Can anyone tell me what would be a standard and customary fee for a Medical Assistant to give a vaccine/shot etc does it vary by vaccine? Is it more expensive to give flu shot than an hpv shot? I found out a friend got an hpv shot which was like $240 for the vaccine and $61 for the MA to give the injection. $61 bucks? does that sound right? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 30, 2011 Report Share Posted October 30, 2011 Other exception is pneomovax for Medicare. G0009 admin code. And if you give pneumovax and flu, the ICD-9 becomes V06.6 (this is off the top of my head, so don't quote me on it!) for both vaccines. Gotta love when they change something that wasn't broken! The G codes are reimbursable with an E & M code with no modifier :-) Pratt Hi , For MA administration fee reimburse rate in your geographic area, you can go to www.cms.gov --> Medicare --> Physician fee schedule look up, the web site is: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx Typically, for the first vaccination of the visit, CPT code is 90471, each following is 90472. Most time, it doesn't matter which vaccine. Of cource you charge the CPT code for the vaccination you give. Insurances reimburse rate varies: roughly $10 - 30. The exception is Flu shot this year. Medicare listed different flu shots with different administraion fee. For example: One of the Flu vaccines: CPT Q2036, Admin: G0008. Your friend can charge whar ever he wants, but Medicare and insurances have their contract fee. Unless out of network, and his patients are willing to pay. How this is helpful. Wen LiangSan Mateo, CA ,Do you participate with insurance? There are codes for that. Generally my 90471 charge which is injection of a single antigen vaccine in adults is $25 and I get paid anywhere from $9 to $25 for it. There are different codes for babies and younger kids which have a higher charge associated with it because of “counseling”. All the prices from your friend sound high. But don’t forget the administration fee includes storage, VIS sheet production, documentation costs, etc. Kathy Saradarian, MDBranchville, NJ www.qualityfamilypractice.com Solo 4/03, Practicing since 9/90Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of Sent: Friday, October 28, 2011 10:16 PMTo: Subject: vaccine fees Can anyone tell me what would be a standard and customary fee for a Medical Assistant to give a vaccine/shot etc does it vary by vaccine? Is it more expensive to give flu shot than an hpv shot? I found out a friend got an hpv shot which was like $240 for the vaccine and $61 for the MA to give the injection. $61 bucks? does that sound right? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 4, 2011 Report Share Posted November 4, 2011 That's not high. I charge 30 for the flu shot and 25 to administor. I usually get 12 for the flu and 15 for the administration. It is confusing to patients. To: Sent: Tuesday, November 1, 2011 4:40 PMSubject: Re: vaccine fees Some people complain that my fees are high when they see their EOBs. I officially charge a total of $60 for a flu shot plus administration. But that is because it seems that some payers pay a lot for administration and not enough for the shot itself, and others are vice versa, but they end up paying the same in total. So to capture all dollars, both fees need to be high. I do a PATOS discount, so cash-pay patients pay about the same as insurance. But it takes a long time to explain that to some people so that they can understand it. Our payment system ensures that nothing makes sense, and no one can ever tell what they are really paying for. Haresch>> Can anyone tell me what would be a standard and customary fee for a Medical> Assistant to give a vaccine/shot etc> > does it vary by vaccine? Is it more expensive to give flu shot than an hpv> shot?> > I found out a friend got an hpv shot which was like $240 for the vaccine and> $61 for the MA to give the injection. $61 bucks? does that sound right?> > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.