CPT code 90585 is a code used to identify the administration of the BCG vaccine through the skin for healthcare providers.
CPT code 90585 is used to describe the administration of the Bacillus Calmette-Guérin (BCG) vaccine via the percutaneous route. This vaccine is primarily used for the prevention of tuberculosis (TB) and is administered by puncturing the skin, allowing the vaccine to be absorbed directly. The BCG vaccine is often given in areas where TB is prevalent or for individuals at higher risk of exposure. This code is utilized by healthcare providers to accurately document and bill for the administration of this specific vaccine.
For CPT code 90585, which pertains to the BCG vaccine administered percutaneously, 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 applicable if the vaccine is administered 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 BCG vaccine is administered 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 if the BCG 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. While not typically applicable to vaccine administration, this modifier could be used if the administration is part of a telehealth service where the provider is guiding the administration remotely.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided.
These modifiers should be used in accordance with payer guidelines and specific clinical scenarios to ensure accurate billing and reimbursement.
The CPT code 90585 is related to the administration of a vaccine. To determine if this specific CPT code is reimbursed by Medicare, one must refer to the Medicare Physician Fee Schedule (MPFS) and consult with the relevant Medicare Administrative Contractor (MAC) for your region. The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. However, it is important to note that not all vaccine-related services are covered under Medicare Part B, as some may fall under Medicare Part D or may not be covered at all. Therefore, it is crucial to verify with your MAC, as they have the authority to provide guidance on coverage and reimbursement specifics for your locality.
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