CPT code 90460 is used to identify the administration of the first or only component of a vaccine for immunization purposes.
CPT code 90460 is used to report the administration of the first or only component of a vaccine or toxoid when counseling is provided by a physician or other qualified healthcare professional. This code is specifically applicable when the patient or their guardian receives counseling about the vaccine, and it is typically used in pediatric settings where vaccines are administered with accompanying guidance. The code covers the work involved in the administration and the educational component, ensuring that the patient or guardian understands the benefits and potential side effects of the vaccine.
For CPT code 90460, which involves the administration of the first or only component of a vaccine or toxoid, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed in addition to the vaccine administration.
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 applicable if multiple vaccine administrations are performed and need to be distinguished from each other.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same vaccine administration is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the same vaccine administration is repeated on the same day by a different provider.
5. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration counseling is provided through telemedicine.
6. Modifier 99: Multiple modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90460 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. However, it's important to note that the reimbursement for CPT code 90460 can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) for the provider's region. MACs are responsible for processing Medicare claims and have the authority to interpret and implement Medicare policies, which can influence the reimbursement process for specific CPT codes like 90460. Therefore, healthcare providers should consult their local MAC for precise reimbursement details and any additional requirements that may apply.
Discover the power of MD Clarity's RevFind software to ensure you're receiving every dollar you're owed. With the ability to read your contracts and detect underpayments down to the CPT code level, including CPT code 90460, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and enhance 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
