CPT code 90626 is a code used to identify the administration of the tic-brain encephalitis vaccine in a 0.25ml intramuscular dose.
CPT code 90626 is used to describe the administration of a tick-borne encephalitis vaccine, specifically in a 0.25 ml dosage given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the vaccination service provided to protect against tick-borne encephalitis, a viral infection transmitted by ticks.
For CPT code 90626, which pertains to the administration of the tick-borne encephalitis vaccine, 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.
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. Although not typically used for vaccine administration, this modifier could be applicable 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 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. It is important to verify payer-specific guidelines, as the applicability of modifiers can vary.
CPT code 90626 is associated with a specific service or procedure, and whether it is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) for the region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. Each MAC, which is responsible for processing Medicare claims, may have specific guidelines and coverage determinations that affect reimbursement.
To determine if CPT code 90626 is reimbursed by Medicare, healthcare providers should consult the latest MPFS to see if the code is listed and check with their local MAC for any specific coverage policies or requirements. Additionally, providers can use the Medicare Coverage Database or contact their MAC directly for the most accurate and up-to-date information regarding the reimbursement status of CPT code 90626.
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