CPT code 90625 is a code used to identify the cholera vaccine administered orally, facilitating accurate documentation and communication in healthcare.
CPT code 90625 is used to identify the administration of a live oral cholera vaccine. This code is utilized by healthcare providers to document and bill for the provision of this specific vaccine, which is designed to prevent cholera, a bacterial infection often spread through contaminated water. The use of this code ensures accurate tracking and reimbursement for the vaccine's administration within the healthcare revenue cycle.
For CPT code 90625, which pertains to the cholera vaccine live oral, the following modifiers may be applicable depending on the specific circumstances of the service provided:
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 necessary 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. This modifier is used if the vaccine counseling or related services are provided via telemedicine.
6. Modifier 99: Multiple Modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers should be applied based on the specific context of the service provided and the payer's guidelines. Proper use of modifiers ensures accurate billing and reimbursement for the services rendered.
CPT code 90625, which pertains to a specific medical service, 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 by Medicare Part B.
Additionally, it is essential to verify with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies. The MAC may have local coverage determinations (LCDs) that affect whether CPT code 90625 is reimbursed.
Therefore, checking both the MPFS and consulting with your MAC is crucial for accurate reimbursement information.
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