CPT code 90587 is used to identify the administration of the dengue vaccine, specifically a three-dose subcutaneous series.
CPT code 90587 is used to identify the administration of a dengue vaccine, specifically a quadrivalent (four-strain) vaccine that is given in a three-dose series via subcutaneous injection. This code is utilized by healthcare providers to document and bill for the vaccination service provided to protect against dengue fever, a mosquito-borne viral infection. The use of this code ensures accurate tracking and reimbursement for the vaccine administration within the healthcare revenue cycle.
For CPT code 90587, which pertains to the administration of the dengue vaccine, certain modifiers may be applicable depending on the specific circumstances of the service provided. Below is a list of potential modifiers that could be used with this CPT code, along with the reasons for their use:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. Use this modifier if an evaluation and management (E/M) service was performed on the same day as the vaccine administration and is distinct from the vaccine service.
2. Modifier 59: Distinct Procedural Service. This modifier may be used if the vaccine administration is performed in conjunction with another procedure or service that is not typically reported together, and it is necessary to indicate that the services are distinct and separate.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Use this modifier if the dengue vaccine is administered more than once on the same day by the same provider, which is uncommon but may be necessary in specific clinical scenarios.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is applicable if the 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. Although not typically applicable to vaccine administration, if any part of the service involves telemedicine, this modifier may be relevant.
6. Modifier 99: Multiple Modifiers. Use this modifier when two or more modifiers are necessary to describe the service provided accurately.
These modifiers should be applied based on the specific circumstances of the service provided and in accordance with payer policies and guidelines. Always ensure proper documentation to support the use of any modifiers.
The CPT code 90587, which is associated with the dengue vaccine, quad 3 dose subcutaneous administration, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not list this particular CPT code for reimbursement, indicating that it is not covered under standard Medicare Part B benefits.
Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage specifics, typically follow the MPFS guidelines. Therefore, healthcare providers should be aware that claims submitted for CPT code 90587 are unlikely to receive reimbursement from Medicare, and alternative payment arrangements may need to be considered for patients covered under this program.
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