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February Billing Newsletter | MD Medical Group

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COVID-19 VACCINES GUIDELINES

COVID 19 VACCINE AGES TYPE OF CODE CPT ECW CPT NAME

EFFECTIVE

J&J

(JANSSEN)

18 & OLDER

VACCINE

1ST DOSE ADMIN

91303

0031A

COVID 19 (JANSSEN) >18YRS

COVID-19 IM ADMIN (J&J) BOOSTER

COMPONENT

2/27/2021

VACCINE

91301

COVID 19 (MODERNA) >18YRS

1ST DOSE ADMIN

2ND DOSE ADMIN

0011A

0012A

COVID-19 IM ADMIN (MODERNA) 1ST

COMPONENT

COVID-19 IM ADMIN (MODERNA) 2ND

COMPONENT

12/18/2020

MODERNA

18 & OLDER

3RD DOSE ADMIN

0013A

COVID-19 IM ADMIN (MODERNA) 3RD

COMPONENT

BOOSTER VACCINE

BOOSTER ADMIN

91306

0064A

BOOSTER-COVID 19 (MODERNA-0.25ML)

>18YRS *7990

COVID-19 IM ADMIN (0.25 ML MODERNA)

BOOSTER COMPONENT

10/20/2021

VACCINE

91300

COVID-19 (PFIZER) >12YRS

1ST DOSE ADMIN

0001A

COVID-19 IM ADMIN (PFIZER) 1ST

COMPONENT

8/12/2021

PURPLE

2ND DOSE ADMIN

0002A

COVID-19 IM ADMIN (PFIZER) 2ND

COMPONENT

3RD DOSE ADMIN

0003A

COVID-19 IM ADMIN (PFIZER) 3RD

COMPONENT

10/20/2021

PFIZER

12 & OLDER

BOOSTER ADMIN 0004A COVID-19 IM ADMIN (PFIZER) BOOSTER 9/22/2021

VACCINE

91305

COVID 19 (PFIZER- GRAY) >12YRS

1ST DOSE ADMIN

0051A

COVID-19 IM ADMIN (PFIZER-GRAY) 1ST

DOSE

GRAY

2ND DOSE ADMIN

0052A

COVID-19 IM ADMIN (PFIZER-GRAY) 2ND

DOSE

1/3/2022

3RD DOSE ADMIN

0053A

COVID-19 IM ADMIN (PFIZER-GRAY) 3RD

DOSE- IMMUNO

BOOSTER ADMIN

0054A

COVID-19 IM ADMIN (PFIZER-GRAY)

BOOSTER

VACCINE

91307

COVID 19 (PFIZER) PEDIATRIC 5-11YRS

PFIZER

PEDIATRICS

ORANGE

CHILDREN

5-11

1ST DOSE ADMIN

2ND DOSE ADMIN

0071A

0072A

COVID-19 IM ADMIN CHILD - (PFIZER) 1ST

COMPONENT

COVID-19 IM ADMIN CHILD - (PFIZER) 2ND

COMPONENT

10/29/2021

Do not collect from self-pay patients for COVID vaccines and/or Free COVID testing.


R E M I N D E R S

PATIENTS' BENEFIT VERIFICATION

Please be sure we are verifying:

Benefits on all patients as well as collecting

co-pays, deductibles and/or co-insurances at

the time of the service. (please use Master

Fee Schedule for collecting deductibles / coinsurances)

Patient's benefits through TMHP and

payor's portal every time a patient returns

to clinic.

That the provider is linked to Topcare

Medical Group Inc.

Benefits to know if Sports Physical is a

covered benefit, for Superior Ambetter

PAYOR SPECIFIC

All Medicaid Insurance needs to be verified

on the 1st of every month.

If patient has a Dual Plan please make sure

you use the presentation provided "Dual

Policies" to verify insurance and load

correct Medicaid and Medicare plans.

If patient has CHC we must obtain

authorization for CPT 17340 prior to

performing.

If the patient has BCBS HMO then they

should not add BCBS PPO to the patients

account but add BCBS HMO insurance

record.

PATIENTS' INFORMATION

Please remember to update patient's

information such as address and telephone

number. Please update Medicare patient

accounts with their new identification cards.

Make sure that for children the

demographics contains

GUARANTOR/RESPONSIBLE PARTY. We

are seeing numerous account where this is

missing.

If patient with insurance signs the "Self-Pay

Form" please remove insurance from claim

at the time of creation.

PATIENT BALANCE

If patient has an outstanding balance, please

collect balances based upon our payment

arrangements and/or call CBO to resolve

with patient collections (ext. 8124)

PCP INFORMATION LOGIN

For all HMO’s, staff should update the PCP

to our provider treating the patient at the

time of service.

Amerigroup has finished loading

Amerivantage to our providers. You can call

Amerigroup and they should be able to

change PCP.

EMPLOYEE FEE SCHEDULE

If employee is coming for Office Visit,

choose "Employee Fee Schedule" and

adjust $0.01 under employee adjustment

only. Do not adjust any other service

done. Charges from "Employee Fee

Schedule" are already adjusted and should

be collected when performed.

Give your best effort, because

you are worth your best results.

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