Billing Newsletter | April 2022

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
MODERNA
18 & OLDER
1ST DOSE ADMIN
2ND DOSE ADMIN
3RD DOSE ADMIN
BOOSTER VACCINE
BOOSTER ADMIN
0011A
0012A
0013A
91306
0064A
COVID-19 IM ADMIN (MODERNA) 1ST
COMPONENT
COVID-19 IM ADMIN (MODERNA) 2ND
COMPONENT
COVID-19 IM ADMIN (MODERNA) 3RD
COMPONENT
BOOSTER-COVID 19 (MODERNA-0.25ML)
>18YRS *7990
COVID-19 IM ADMIN (0.25 ML MODERNA)
BOOSTER COMPONENT
12/18/2020
10/20/2021
VACCINE
91300
COVID-19 (PFIZER) >12YRS
PURPLE
1ST DOSE ADMIN
2ND DOSE ADMIN
3RD DOSE ADMIN
0001A
0002A
0003A
COVID-19 IM ADMIN (PFIZER) 1ST
COMPONENT
COVID-19 IM ADMIN (PFIZER) 2ND
COMPONENT
COVID-19 IM ADMIN (PFIZER) 3RD
COMPONENT
8/12/2021
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
GRAY
1ST DOSE ADMIN
2ND DOSE ADMIN
3RD DOSE ADMIN
BOOSTER ADMIN
0051A
0052A
0053A
0054A
COVID-19 IM ADMIN (PFIZER-GRAY) 1ST
DOSE
COVID-19 IM ADMIN (PFIZER-GRAY) 2ND
DOSE
COVID-19 IM ADMIN (PFIZER-GRAY) 3RD
DOSE- IMMUNO
COVID-19 IM ADMIN (PFIZER-GRAY)
BOOSTER
1/3/2022
PFIZER
PEDIATRICS
ORANGE
*Effective 03/28/2022
CHILDREN
5-11
VACCINE
1ST DOSE ADMIN
2ND DOSE ADMIN
91307
0071A
0072A
Self-Pay/Underinsured Patients: Vaccine administration will be FREE. Per the Centers for Disease Control and Prevention’s
Requirements for COVID-19 Vaccination Program Providers, providers must continue to administer COVID-19 vaccines at no
out-of-pocket cost to recipients.
Process for COVID Vaccines:
Document in ECW (as any other service) by creating a progress note.
Create a claim
Adjust the claim using TERMCVD adjustment code.
COVID 19 (PFIZER) PEDIATRIC 5-11YRS
COVID-19 IM ADMIN CHILD - (PFIZER) 1ST
COMPONENT
COVID-19 IM ADMIN CHILD - (PFIZER) 2ND
COMPONENT
10/29/2021
*Updates found in green font.

I M P O R T A N T I N F O R M A T I O N
Patients with
balance
Please allow to pay at the
clinic. We should never turn
patients that want to make a
payment away.
Questions about balance – Billing dpto. 972-957-3000 option 2.
Payment by phone – Patient Payment Collectors: Nuvia Lucio ext.
8124
Patient Collections phone number – 1 800 711 6521
Medical Record Requests need to be sent to – Email:
mdmedical@dmrs.net / Fax (213) 225-5070 / Phone (800) 359-8520
Patient refunds
need an allowance period of 30 days to complete
processing.
Locums : Make sure progress note is signed and scanned, the correct template
is used (acute / preventive), if correct template is needed, please ask RDO.
Locum providers should never see Medicare patients.
How to code new/established visits
on the same day.
(when the patient is truly a new patient to our facilities)
PAYOR GROUP PATIENT AGE RULE CPTS YOU MAY USE
COMMERCIAL
ALL AGES
Well visits are going to be
billed as a new patient
sick visits billed as if
patient was established
99381 - 99387
99211 -99215
0 - 20 YEARS
Well visits are going to be
billed as a new patient
99381 -
99385
99201 -
99205
MEDICAID
21 YEARS AND
MORE
Well visits are going to be
billed as a new patient
Sick visits billed as if
patient was established.
99385 - 99387
99211 - 99215
If visit is done by a Locum, two separate notes will need to be attached to the patients file

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.
"A little progress everyday adds
up to BIG results"