Month: December 2023
Help Identifying BCBS cards
The following Network IDs only apply to cards that show the TDI indicator.
This shows the plan is fully funded and regulated by TDI (Texas Department of Insuarnce).
- Blue Choice PPOSM= BCA.
- Blue EssentialsSM = HMO.
- Blue Advantage HMOSM = BAV.
- Blue PremierSM = HMH.
- MyBlue HealthSM = BFT.
- Blue High Performance (BlueHPN) = HPN
Example of Blue EssentialsSM
Note the red letters “HMO” and blue letters “TDI” on the card. This is what makes it a Blue Essentials Card.
However, with the ever-changing insurance landscape,
We highly encourage you to check Eligibility and Benefits.
It is advisable to retain any information you view, for your office to have the documentation you
need when a claim does not pay correctly or does not pay at all.
REMEMBER: IT HAS TO HAVE THE TDI INDICATOR
Don’t Miss UHC Updates
Texas Medicaid: Adjustment reimbursement methods coming soon
Texas Medicaid: Prior autorization updates for certain medications
COVID-19 CPT vaccine and immunization codes
After the 2024 CPT book was printed, the AMA deleted 64 codes and Appendix Q.
COVID-19 Vaccines
Administration
• 90480 – Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
Vaccine Product
• 91318 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (6
months to 4 years) Pfizer
• 91319 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (5-11
years) Pfizer
• 91320 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, forintramuscular use (12 years and older) Pfizer
• 91321 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25mL dosage, for intramuscular use (6 months – 11 years) Moderna
• 91322 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use (12 years and older) Moderna
Receive More Accurate Payment for Medicare Complex Visits.
The new code will take effect Jan. 1, 2024. The 2024 Medicare Physician Fee Schedule allows physicians to list G2211 in addition to codes used in-office or outpatient visits for new or established patients (i.e., 99202-99215). Physicians can also use it for telehealth visits.
Texas Medical Association continues to push for additional guidance as confusion over the code’s use persists.
Medicare Physician Fee Schedule: New CPT Codes for RSV Vaccine Administration
Please Read Carefully
If your patient doesn’t have Medicare Part D, Medicare will pay for vaccine administration.
but not the vaccine under Part B.
CMS retroactively added 2 new CPT codes for respiratory syncytial virus (RSV) vaccine administration to the Medicare Physician Fee Schedule effective for dates of service on and after October 6, 2023:
- 96380 – Short descriptor: Admn rsv monoc antb im cnsl
- 96381 – Short descriptor: Admn rsv monoc antb im njx
Your Medicare Administrative Contractor will adjust claims you bring to their attention.
Recent Comments