CPT code 90586 is a medical code used to identify the administration of the BCG vaccine intravesically for bladder cancer treatment.
CPT code 90586 is used to describe the administration of the Bacillus Calmette-Guérin (BCG) vaccine directly into the bladder, a procedure known as intravesical instillation. This treatment is primarily used for bladder cancer and involves introducing the BCG vaccine into the bladder to stimulate the immune system to attack cancer cells. The code is utilized by healthcare providers to document and bill for this specific therapeutic procedure.
For the CPT code 90586, which pertains to the BCG vaccine administered intravesically, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. If the administration of the BCG vaccine intravesically involves significantly more effort or complexity, this modifier may be appropriate.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: If an evaluation and management (E/M) service is provided on the same day as the BCG vaccine administration and is distinct from the procedure itself, this modifier should be used.
3. Modifier 51 - Multiple Procedures: This modifier is applicable when multiple procedures are performed during the same session. If the BCG vaccine is administered along with other procedures, Modifier 51 may be used to indicate this.
4. 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. If the BCG vaccine administration is performed in a separate session or is distinct from other services, Modifier 59 may be appropriate.
5. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: If the BCG vaccine is administered more than once on the same day by the same provider, Modifier 76 can be used to indicate the repeat service.
6. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: If the BCG vaccine is administered more than once on the same day by a different provider, Modifier 77 should be used.
7. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although typically used for laboratory tests, if the BCG vaccine administration is repeated for clinical reasons, this modifier might be considered to indicate the repeat service.
These modifiers help provide additional information about the circumstances under which the BCG vaccine is administered, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements to ensure proper use of modifiers.
CPT code 90586, which pertains to the BCG vaccine administered intravesically, is reimbursed by Medicare under specific conditions. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. However, the actual reimbursement can vary based on the local policies set by the Medicare Administrative Contractor (MAC) responsible for the region where the service is provided. Each MAC may have specific guidelines and coverage determinations that influence whether and how much Medicare reimburses for CPT code 90586. Therefore, healthcare providers should consult their local MAC for detailed information on coverage and reimbursement rates for this specific code.
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