CPT code 90466 is for additional immunization injections given to children under 8 years old, ensuring accurate tracking of vaccine administration.
CPT code 90466 is used to describe the administration of an additional vaccine or toxoid injection for a patient under the age of 8. This code is specifically applied when multiple vaccines are administered during the same visit, and it accounts for the extra work involved in administering each additional injection beyond the first. It is important for healthcare providers to use this code to ensure accurate billing and reimbursement for the additional immunization services provided to young patients.
For CPT code 90466, which involves the administration of an additional vaccine or toxoid injection for children under 8 years, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management 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 injections are administered 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 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 healthcare professional. This modifier is used if the procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for vaccine administration, this modifier might be relevant if the context involves repeated testing related to the administration.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Always verify with current payer policies and guidelines, as modifier usage can vary.
CPT code 90466, which involves immune administration for additional injections for patients under 8 years old, is subject to reimbursement by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, it is crucial to verify with the local Medicare Administrative Contractor (MAC), as they have the authority to interpret national Medicare policies and may have specific guidelines or coverage determinations that affect reimbursement for CPT code 90466. The MACs are responsible for processing Medicare claims and can provide detailed information on whether this particular code is reimbursed in your jurisdiction.
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