CPT code 90627 is a code used to identify the administration of the tic-brain encephalitis vaccine in a 0.5ml intramuscular dose.
CPT code 90627 is used to identify the administration of the tick-borne encephalitis vaccine, specifically a 0.5 ml dose given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the vaccination service, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle. The vaccine is designed to protect against tick-borne encephalitis, a viral infection transmitted by ticks, which can lead to serious neurological complications.
For CPT code 90627, which pertains to the tick-borne encephalitis vaccine administered intramuscularly, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used if a significant, separately identifiable E/M service is provided in addition to 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 the same physician or other qualified healthcare 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 healthcare 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 administration is part of a telemedicine service, although this is less common for vaccine administration.
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 for the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90627 is related to a specific medical service or procedure. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the relevant Medicare Administrative Contractor (MAC) for your region. The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. Each MAC may have specific coverage policies and reimbursement rates that can vary by locality.
For CPT code 90627, you would need to verify its inclusion in the MPFS and check with your local MAC to confirm if it is covered and reimbursed by Medicare. Coverage can depend on various factors, including medical necessity, the setting in which the service is provided, and any applicable local coverage determinations (LCDs) or national coverage determinations (NCDs). It is advisable to regularly review updates from both the MPFS and your MAC to ensure compliance and accurate billing practices.
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