CPT code 90393 is a specific code used to identify the administration of a vaccine for immunization purposes in healthcare settings.
CPT code 90393 is used to describe the administration of vaccinia immune globulin (VIG) via intramuscular injection. This code is typically utilized in scenarios where a patient requires passive immunization against the vaccinia virus, which is associated with smallpox vaccination. The use of VIG is often indicated for individuals who have had adverse reactions to the smallpox vaccine or are at high risk of complications from the vaccinia virus. This code helps healthcare providers accurately document and bill for the administration of this specific immune globulin therapy.
For CPT code 90393, which pertains to the administration of vaccinia immune globulin intramuscularly, the following modifiers may be applicable:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. This modifier is used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
2. Modifier 59: Distinct Procedural Service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if the administration of the immune globulin is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by the same provider on the same day.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider on the same day.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. While not typically used for vaccine administration, this modifier could be relevant if the administration is part of a diagnostic process that requires repetition.
These modifiers help clarify the circumstances under which the procedure was performed and ensure accurate billing and reimbursement. It is important to review the specific payer guidelines, as modifier usage can vary between insurance carriers.
CPT code 90393 is associated with a specific immunization procedure. To determine if this code is reimbursed by Medicare, one must consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the relevant Medicare Administrative Contractor (MAC) for your region. The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. It is important to note that not all CPT codes are covered under Medicare, and coverage can vary based on the specific circumstances and the MAC's local coverage determinations (LCDs).
For CPT code 90393, you would need to verify its status on the MPFS to see if it is listed and whether it has an assigned reimbursement rate. Additionally, checking with your regional MAC is crucial, as they provide specific guidance on coverage policies and any additional documentation requirements that might be necessary for reimbursement. If the code is not listed on the MPFS or if the MAC has not provided coverage guidelines, it is likely that Medicare does not reimburse for this particular CPT code. Always ensure to stay updated with the latest MPFS and MAC guidelines, as these can change annually or even more frequently.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 90393, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
