CPT code 90621 is a code used to identify the MenB-FHbp vaccine, specifically for the second of three doses administered via injection.
CPT code 90621 is used to identify the administration of the meningococcal B vaccine, specifically the MenB-FHbp vaccine, which is given in either a two-dose or three-dose series via intramuscular injection. This vaccine is designed to protect against meningococcal disease caused by Neisseria meningitidis serogroup B, a serious bacterial infection that can lead to life-threatening conditions such as meningitis and bloodstream infections. The code is utilized by healthcare providers to accurately document and bill for the vaccine's administration in a clinical setting.
For CPT code 90621, which pertains to the MenB-FHbp vaccine administered intramuscularly in a 2- or 3-dose schedule, 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 is administered in conjunction with other procedures that are not typically performed 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 but possible in specific clinical scenarios.
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 applicable to vaccine administration, this modifier might be used if the vaccine is part of a telehealth service where the administration is coordinated remotely.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is provided to the healthcare provider at no cost by the state.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is essential to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90621, which refers to a specific vaccination, is subject to reimbursement by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, it's important to check with the specific Medicare Administrative Contractor (MAC) that processes claims in your region, as they may have local coverage determinations or specific guidelines regarding the reimbursement of this vaccination code. The MACs play a crucial role in interpreting national Medicare policies and applying them to local circumstances, which can affect whether a particular service, such as the one associated with CPT code 90621, is reimbursed.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 90621, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
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