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Health plans, Medicare contractors, and recovery auditors commonly review claims involving: Duplicate injection administrations Unsupported Modifier 25 usage Missing HCPCS drug codes Incorrect HCPCS units Administration without documentation Vaccine miscoding Improper unbundling Diagnosis-to-drug mismatches Repeated administration services Incomplete medical necessity Even small documentation deficiencies can lead to payment delays, additional documentation requests, or post-payment recoupments when identified across large claim volumes
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