CPT code 90476 is a specific code used to identify the administration of the adenovirus vaccine type 4 in healthcare documentation.
CPT code 90476 is used to identify the administration of the adenovirus vaccine type 4. This code is specifically designated for billing and documentation purposes when a healthcare provider administers this particular vaccine to a patient. The adenovirus vaccine type 4 is typically used to prevent infections caused by adenovirus, which can lead to respiratory illnesses. This code helps ensure accurate tracking and reimbursement for the vaccine administration within the healthcare revenue cycle.
For CPT code 90476, which pertains to the administration of the adenovirus vaccine type 4, 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 vaccines 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 vaccine is administered more than once on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the same vaccine is administered more than once on the same day by a different provider.
5. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration counseling is provided through telemedicine.
6. Modifier 99: Multiple modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90476, which is associated with the adenovirus vaccine type 4, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not include this particular CPT code for reimbursement, as Medicare typically does not cover vaccines that are not directly related to influenza, pneumococcal, or hepatitis B for high-risk individuals.
Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage specifics, generally follow the guidelines set forth by the MPFS. Therefore, healthcare providers should be aware that claims submitted to Medicare for CPT code 90476 will likely not be reimbursed.
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