CPT CODES

CPT Code 90461

CPT code 90461 is used to report the administration of each additional component of a vaccine for immunization purposes.

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What is CPT Code 90461

CPT code 90461 is used to describe the administration of each additional vaccine or toxoid component when multiple components are included in a single vaccine product. This code is typically used in conjunction with CPT code 90460, which covers the initial vaccine or toxoid component administered to a patient. The purpose of CPT code 90461 is to ensure that healthcare providers are accurately reimbursed for the time and resources involved in administering complex vaccines that contain multiple components, such as combination vaccines. This code is particularly relevant in pediatric care, where combination vaccines are commonly used to protect against multiple diseases with a single injection.

Does CPT 90461 Need a Modifier?

For CPT code 90461, which is used for the administration of each additional vaccine or toxoid component, 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 necessary if multiple vaccine administrations are performed and need to be distinguished from one another.

3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used when the same procedure 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 when the same procedure is repeated on the same day by a different provider.

5. Modifier 91: Repeat clinical diagnostic laboratory test. While not typically associated with vaccine administration, this modifier may be relevant if the administration involves a diagnostic component that needs to be repeated.

These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is essential to use them appropriately to avoid claim denials or delays.

CPT Code 90461 Medicare Reimbursement

CPT code 90461, which refers to the administration of each additional component of a vaccine, is indeed reimbursed by Medicare under specific circumstances. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries. However, it's important to note that the reimbursement can vary based on the geographical location and specific policies set by the Medicare Administrative Contractor (MAC) responsible for the region. Each MAC may have different guidelines and coverage determinations, so it's crucial for healthcare providers to verify the specific reimbursement details with their local MAC to ensure compliance and accurate billing.

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