CPT code 90474 is used to identify the administration of additional oral or nasal vaccines for immune protection.
CPT code 90474 is used to describe the administration of an additional dose of a vaccine via the oral or nasal route. This code is specifically utilized when a healthcare provider administers a subsequent dose of a vaccine after the initial dose has been given. It is important for accurate billing and documentation in the healthcare revenue cycle, ensuring that providers are reimbursed appropriately for the services rendered. This code is typically used in conjunction with other codes that describe the initial vaccine administration.
For CPT code 90474, which pertains to the administration of an additional oral or nasal vaccine, 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 an E/M service is provided on the same day as the vaccine administration, and the E/M service is distinct and necessary.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the vaccine administration is distinct or independent from other services performed on the same day. It is typically used to prevent bundling of services that are usually considered part of a single procedure.
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 performed more than once 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 performed more than once on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not commonly used with vaccine administration, this modifier may be applicable if the administration is part of a diagnostic process requiring repeated tests.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to apply the appropriate modifier based on the specific circumstances of the service provided.
CPT code 90474, which refers to the administration of an additional oral or nasal vaccine, 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. The MPFS provides detailed information on whether a particular CPT code is reimbursable and the associated payment amount.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on coverage and payment policies for specific CPT codes, including 90474. Providers should verify with their local MAC to ensure that the administration of an additional oral or nasal vaccine is covered and to understand any specific documentation or billing requirements that may apply.
In summary, while CPT code 90474 may be reimbursed by Medicare, it is essential for healthcare providers to review the MPFS and consult with their MAC to confirm coverage and compliance with Medicare's billing guidelines.
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