CPT code 90473 is a code used to identify the administration of an oral or nasal immune product, helping streamline healthcare documentation and processes.
CPT code 90473 is used to describe the administration of an immunization via the oral or intranasal route. This code is specifically for the service of delivering a vaccine through these non-injection methods, which can include vaccines like the oral polio vaccine or the intranasal influenza vaccine. It is important for healthcare providers to use this code to accurately document and bill for the administration of vaccines that do not require a needle, ensuring proper reimbursement and maintaining precise patient records.
For CPT code 90473, which pertains to the administration of immunizations via oral or nasal routes, 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 immunization administration.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the immunization administration is distinct or independent from other services performed on the same day.
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 immunization administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although primarily used for lab tests, this modifier can sometimes be applied if the immunization administration is repeated for clinical reasons.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the immunization administration counseling is provided through telemedicine.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90473, which is related to the administration of vaccines via oral or nasal routes, is reimbursed by Medicare under specific conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the local policies set by the Medicare Administrative Contractor (MAC) in your region. Each MAC may have specific guidelines or requirements for the reimbursement of CPT code 90473, so it is essential to consult the MAC's local coverage determinations (LCDs) and any relevant billing instructions. Providers should ensure that they meet all necessary criteria and documentation requirements to facilitate proper reimbursement for this service.
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