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  • Tricare not paying the admin for state supplied vaccines?
    Is there a reason why Tricare patients are being given state supplied vaccines? In NY the state supplied vaccines (VFC program) can only be given to patients who are uninsured or are underinsured Which would make sense as to why Tricare is not reimbursing for the admin fee If your Tricare patients are fully insured they should be receiving vaccines that were paid for by the office that is
  • 90460 and 90461 denials | Medical Billing and Coding Forum - AAPC
    We are getting several denials for the new vaccine admin codes, 90460 We are billing them out on separate lines (not using multiple units) but they are being denied as duplicates I read somewhere that the admin codes need to be "lumped" with their respective vaccine codes on a single claim
  • Tricare Is Usually Secondary : Reader Question - AAPC
    Here’s why: Tricare is always the secondary payer—with a few exceptions If a particular patient has Tricare as well as insurance through another source, you should almost always consider the other insurance primary
  • Tricare Use of Modifier SA for Physician Assistants?
    Hello - I have two questions related to SA modifier and specific to Tricare (if anyone knows) : For a physician who is billing for a Physician Assistant who performs services, is the SA modifier the appropriate modifier to use in all cases? My outpatient practice (behavioral health) is having
  • Tricare Address Needed | Medical Billing and Coding Forum - AAPC
    Hello Everyone, Our office has a lot of Tricare patients (West Region) As of 01 01 2018 UnitedHealthCare no longer processes claims for Tricare Healthnet took Tricare over I have searched the internet for the new claims address with no luck I have tried to call them since the first of the
  • Tricare and B L procedures | Medical Billing and Coding Forum - AAPC
    For some time now (1-2 years) Tricare has been paying 100% for some B L procedures, such as Blephs and Breast reductions, instead of paying 100% then 50% they pay 100% for each procedure Now they are requesting refunds on these claims Has anyone run into this and or know where I can find a
  • G0008 with 90471 | Medical Billing and Coding Forum - AAPC
    Originally, Medicare paid for the E M, flu shot and admin (G0008), and denied the tetanus shot admin (90471) We sent in an appeal for the tetanus, so Medicare paid for the tetanus shot admin but then took back the payment for G0008 only, saying the denial is due to incorrect missing modifier
  • Northern California: Tricare4u, TricareForLife, Triwest, VA . . . - AAPC
    Tricare: Active Duty and some retired service members and their families If there is no other coverage that is primary, claims go to: Tricare West Region Claims, c o Healthnet Federal Services, PO Box 202112, Florence, SC, 29502-2112
  • BCBS CO spine denials requesting I use a different code
    Radiology isn't my specialty, but in reviewing the coding I think I would agree with the medical director's decision here I can't find any direction in CPT or the supporting guidance that specifies that the use of codes 72081-72084 is reserved only for cases where the imaging must be done on a single machine or requires 'stitching software' In fact, the CPT descriptions in the codes does
  • Detox and Residential for Tricare West - AAPC
    Has anyone billed Tricare West for Substance Abuse detox and or residential services? We just became par, but they did not and will not provide any information on their requirements for billing UB or HICFA, Rev Codes or HCPCs, etc I've searched their manuals and having no luck there





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