Modifiers in Billing Setup for Vaccines, ESAs, TDAPA, and Other Medications

1. Modifiers in Billing Setup

This slide outlines the modifiers required in billing setup for various vaccines, ESAs, TDAPA medications, and other drugs. For vaccines like influenza, the regular modifier is A6, while the administrative code is G0008. Pneumococcal vaccines also use A6 as the regular modifier, with G0009 as the administrative code. Hepatitis vaccines have an administrative code of G0010. For Aranesp, the regular modifier with no wastage is JZ, and the route is based on JA, JB, and JE, with the bill factor requiring the vial size. Mircera and Venofer also use JZ as the regular modifier with no wastage, JW for wastage, and the same route as Aranesp, with A4657 as an optional administrative code. EPO and Retacrit follow a similar route and administrative code, with a dose range from 0.1 to 99,999.99 and the bill factor requiring the vial size. For TDAPA medications like Vadadustat and Jesduvroq, the administrative code is AX, which is also used for phosphate binders. Finally, for Zemplar, the regular modifier with no wastage is JZ, JW for wastage, and A4657 as an optional administrative code.

2. Vancomycin Modifier

This slide provides billing setup information for Vancomycin. The regular modifier for Vancomycin is AY.