There have been many recent complaints that some payers are requiring modifier -25 to be appended to the preventive medicine visit code when billed with vaccines and vaccine administration. It appears that these payers are using a particular proprietary software and just recently added this edit. If you are experiencing denials because of this issue, there are several steps you can take to try to resolve the issue that have proven to be effective in several areas of the country. If your state chapter has established a pediatric council, work through it. If not, contact other pediatric offices in your area to try to work together as a group to resolve the issue. You should assign a small group or a lead person as a representative to communicate with the payer. Provide the payer with a copy of the Current Procedural Terminology guidelines, as they indicate that “if a significant,...

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