CPT code 90467 is a code used to identify the administration of vaccines for patients under 8 years old.
CPT code 90467 is used to describe the administration of an immunization to a patient who is under 8 years old. This code specifically applies to the administration of a vaccine by oral or nasal routes. It is important for healthcare providers to use this code when billing for the service of administering vaccines to young children, ensuring accurate documentation and reimbursement for the immunization process.
For CPT code 90467, which pertains to the administration of immunizations to children under 8 years of age, 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 an additional E/M service is provided 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 applicable if multiple immunization administrations are performed and need to be reported separately.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same immunization administration is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the same immunization administration 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 discretion of the physician or other qualified healthcare professional.
6. Modifier 53: Discontinued procedure. This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
These modifiers help provide additional information about the services rendered and ensure accurate billing and reimbursement processes. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90467 is associated with the administration of immunizations for patients under 8 years of age. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set forth by the 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 for services rendered. If CPT code 90467 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service. However, the actual reimbursement can vary based on geographic location and other factors determined by the MAC.
MACs are private organizations contracted by Medicare to process claims and determine coverage specifics in different regions. They have the authority to interpret Medicare policies and may have additional guidelines or requirements for the reimbursement of certain CPT codes, including 90467.
To determine if CPT code 90467 is reimbursed by Medicare in your specific case, it is advisable to consult the MPFS for the current year and reach out to your regional MAC for any additional coverage criteria or documentation requirements.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 90467, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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
