Ways To Up Your Menactra Reimbursements

Ways To Up Your Menactra Reimbursements

As of July of this year there is an addition to the coding in the form of
90734 (Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 [tetravalent], for intramuscular use), and 3 insurance companies have a wide difference in reimbursements.

Advance planning in your medical billing, proper patient coding, and exact documentation will help get your practice the ultimate reimbursement for this procedure. The average revenue reimbursement seems to be in the $85-$102 at this time from most carriers.

Three different insurance companies were asked what their reimbursement rates would be for 90734 and received the following responses:

United had not set a fee for 90734 as of July, but the proposed reimbursement for medical billing claims was approximately $92 which is below the AWP (Average Wholesale Price) of this vaccine which is $102.50.

Aetna had issued a corporate recommendation for all regions to set the reimbursement for 90734 on medical billing clams at $87, again which is below the AWP.

Blue Cross had a couple of different reimbursements happening for 90734. If the plan was a Carefirst which is Blue Cross in the states of Maryland and Virginia,the reimbursement was approximated at $87.
Empire Blue and Blue Cross of Florida will honor the AWP of $102.50 for medical billing claims submitted as of May 1st for both HMO and PPO members.

Since a number of insurance companies have set their reimbursements lower than the AWP, many physicians are having the patients make up the difference to meet the AWP. This is done by having patients sign an advance beneficiary notice (ABN) and pay out-of-pocket for the vaccine.

Another way to get around your reimbursements coming in lower than the AWP, is to write a prescription for Menactra to the patient and have the parent purchase the vaccine from the pharmacy. When the patients brings the vaccine to your office for administration, code and charge as 90465-90466, Immunization administration under 8 years of age on your medical billing.

If the patient refuses to pay a part of the charge or purchase the vaccine, refer them to the health department as an option.

View all Articles by: Melissa Clark, CCS-P