CPT code 90611 is a code used to identify the smallpox and monkeypox vaccine, specifically for a 0.5ml dosage.
CPT code 90611 is used to identify the administration of a smallpox and monkeypox vaccine in a 0.5 milliliter dosage. This code is utilized by healthcare providers to document and bill for the vaccination service provided to patients, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90611, which pertains to the administration of the smallpox and monkeypox vaccine, 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 patient receives a vaccine and also has a separate evaluation and management service on the same day.
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 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 needs to be 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 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 might be used if the vaccine administration is part of a telehealth service, although direct administration typically requires in-person interaction.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided.
It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90611, which is associated with the administration of a specific vaccine, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. The MPFS is updated annually and provides a comprehensive list of reimbursable services, including vaccines.
Additionally, it is important to check with the specific Medicare Administrative Contractor (MAC) that processes claims in your region. MACs have the authority to make local coverage determinations (LCDs) that can affect whether a particular service, such as the administration of a vaccine represented by CPT code 90611, is reimbursed. These contractors can provide guidance on any regional variations or additional documentation requirements that may apply.
In summary, while the MPFS is a primary resource for understanding Medicare reimbursement, consulting with your regional MAC is crucial for confirming the reimbursement status of CPT code 90611.
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