CPT code 90619 is a specific code used to identify the MENACWY-TT vaccine for immunization purposes in healthcare settings.
CPT code 90619 is used to identify the administration of the MenACWY-TT vaccine, which is a meningococcal conjugate vaccine. This vaccine is administered intramuscularly (IM) and is designed to protect against four strains of the meningococcal bacteria: A, C, W, and Y. It is commonly used to prevent meningitis and other serious infections caused by these bacteria, particularly in adolescents and young adults. This code is utilized by healthcare providers for billing and documentation purposes when this specific vaccine is given to a patient.
For CPT code 90619, which pertains to the administration of the MenACWY-TT vaccine intramuscularly, the following modifiers may be applicable:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. This modifier is used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as 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 administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the 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 Health Care 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. While not typically used for vaccine administration, this modifier could be relevant if the vaccine counseling or related services are provided via telemedicine.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied to the provider at no cost by the state.
These modifiers help clarify the circumstances under which the vaccine is administered and ensure accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary between insurance carriers.
CPT code 90619, which is associated with the MENACWY-TT vaccine administered intramuscularly, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 90619. They may have local coverage determinations (LCDs) that affect whether and how this code is reimbursed. Therefore, checking both the MPFS and consulting with your MAC will provide the most accurate and up-to-date information regarding the reimbursement status of CPT code 90619 under Medicare.
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