CPT code 90477 is a specific code used to identify the Adenovirus vaccine type 7 for healthcare providers in their documentation and reporting.
CPT code 90477 is used to identify the administration of the adenovirus vaccine type 7. This code is specifically designated for the billing and documentation of the vaccine's delivery to a patient. It is important for healthcare providers to use this code accurately to ensure proper reimbursement and to maintain precise medical records. The adenovirus vaccine type 7 is typically administered to prevent infections caused by the adenovirus, which can lead to respiratory illnesses and other health issues.
For CPT code 90477, which pertains to the administration of the adenovirus vaccine type 7, 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 the vaccine administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the vaccine administration 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 vaccine administration is repeated 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 could be applicable if the administration involves a repeat test on the same day for the same patient.
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 involves telemedicine services, although this is less common for vaccine administration.
These modifiers help clarify the circumstances under which the vaccine administration was performed and ensure accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 90477, which is associated with the administration of the adenovirus vaccine type 7, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not list 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 local coverage decisions, generally follow the guidelines set forth by the MPFS. Therefore, healthcare providers should be aware that claims submitted to Medicare for CPT code 90477 are likely to be denied, and alternative payment arrangements or patient billing may need to be considered.
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