r/CodingandBilling • u/Right-Purchase-2169 • 3d ago

Abrysvo denial

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I work at a gynecology clinic that sees many patients with Medicaid plans. We recently started administering the Abrysvo vaccine in accordance with TMHP requirements for pregnant patients. We are receiving claim denials—supposedly due to the patients' age—even though we are only administering it to patients over 18 who are between 32 and 36 weeks pregnant. Any ideas on what needs to be done to stop these denials?

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u/Different_Level4051 3d ago

I’d double-check the CPT code, gestational age documentation, and payer-specific billing guidelines. If everything is correct, contact the Medicaid MCO to clarify the age-related denial and request a reprocessing or appeal.

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u/Darscht_Jamieria 2d ago

yeah contacting the MCO directly is probably the fastest way to get a clear answer on this one