CPT code 90465 is used to identify the administration of one immunization injection for patients under 8 years old.
CPT code 90465 is used to describe the administration of a single immunization injection for a patient under the age of 8 years. This code specifically applies to the initial vaccine or toxoid administered by a physician or other qualified healthcare professional. It is important to note that this code is used when the administration involves face-to-face counseling of the patient and/or family during the visit. This code is part of the broader category of immunization administration codes, which help healthcare providers accurately bill for the time and expertise involved in delivering vaccines to young patients.
For CPT code 90465, which involves the administration of an immunization injection for patients under 8 years old, 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 immunization 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 injections are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the same procedure is repeated on the same day by a different provider.
5. Modifier 52: Reduced Services. This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
6. Modifier 53: Discontinued Procedure. This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
These modifiers help provide additional information to payers about the circumstances under which the immunization administration was performed, ensuring accurate billing and reimbursement.
CPT code 90465, which involves immune administration for patients under 8 years, is not reimbursed by Medicare. This code has been replaced by other codes in the Medicare Physician Fee Schedule (MPFS) to better align with current billing practices. It's important for healthcare providers to consult the MPFS and their respective Medicare Administrative Contractor (MAC) for the most up-to-date information on reimbursable codes and to ensure compliance with Medicare billing requirements. Always verify with your MAC to confirm the appropriate billing codes for immune administration services.
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