CPT code 90620 is a code used to identify the MenB-4C vaccine administered in two doses via intramuscular injection.
CPT code 90620 is used to identify the administration of the MenB-4C vaccine, which is a meningococcal group B vaccine. This vaccine is designed to protect against meningococcal disease caused by Neisseria meningitidis serogroup B. The "2 dose im" indicates that this vaccine is administered intramuscularly in a two-dose series. This code is utilized by healthcare providers for billing and documentation purposes to ensure accurate reimbursement for the vaccine administration.
For CPT code 90620, which pertains to the MenB-4C vaccine administered in a 2-dose intramuscular series, 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 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, which is unlikely for this specific vaccine but applicable in other scenarios.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. Similar to Modifier 76, this 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 applicable to vaccine administration, this modifier might be used if there is a telehealth component involved in the patient encounter related to the vaccine.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied by the state, indicating that the provider did not incur the cost of the vaccine.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. Always verify payer-specific guidelines, as modifier requirements can vary.
CPT code 90620, which is associated with a specific vaccine, is subject to reimbursement considerations under Medicare. To determine if Medicare reimburses this particular CPT code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and procedures that are covered by Medicare, along with their respective reimbursement rates.
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 guidance on coverage and reimbursement specifics for CPT code 90620. They can also offer insights into any regional variations or additional requirements that may affect reimbursement.
In summary, while CPT code 90620 may be listed in the MPFS, the final determination of reimbursement eligibility and rate should be verified with the appropriate MAC to ensure compliance with Medicare's policies and procedures.
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