Vaccine/Immunization Update
Effective 5/1/10, physician offices are requested to submit National Drug Codes (NDCs) when billing for vaccines and/or toxoids within the CPT range of 90476 through 90749 to assure appropriate reimbursement. If providers elect not to send an NDC for these CPTs, claims will be reimbursed based on the TriWest Fee Schedule, which may result in lower reimbursement. Administration of the immunizations/vaccines (CPT codes 90465 – 90474) will continue to be reimbursed separately.
The following table illustrates the appropriate units that should be submitted based on the billing methodology
.
| Billing Methodology | HCPCS Units | NDC Units | ||||
|---|---|---|---|---|---|---|
| HCPCS Only | X | |||||
| HCPCS plus NDC | X |
Please note that infusion/home health providers are required to submit NDCs when billing for vaccines and/or toxoids and all providers are required to submit NDCs when billing any J-codes
