CPT code 90630 is a code used to identify the flu vaccine IIV4 without preservatives for healthcare providers.
CPT code 90630 is used to identify the administration of an influenza vaccine, specifically the quadrivalent inactivated influenza vaccine (IIV4) that is preservative-free and administered intradermally. This code is utilized by healthcare providers to document and bill for the delivery of this specific type of flu vaccine, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle. The quadrivalent formulation is designed to protect against four different flu virus strains, enhancing the breadth of protection offered to patients.
For CPT code 90630, which pertains to the administration of the influenza vaccine, intradermal, quadrivalent, preservative-free, 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 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 same procedure is repeated by the same provider, which might be relevant in rare cases where multiple doses are administered on the same day due to specific clinical circumstances.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider, which could occur in a multi-provider practice setting.
5. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. While not typically used for vaccine administration, this modifier could be relevant 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 they may have unique requirements for modifier usage.
CPT code 90630 is associated with the administration of a specific type of influenza vaccine. 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 Medicare Administrative Contractor (MAC) for your specific region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers. It includes information on whether a particular service or procedure is covered and the reimbursement rate. For CPT code 90630, you would need to verify its inclusion in the MPFS to confirm its eligibility for reimbursement.
Additionally, MACs play a crucial role in processing Medicare claims and providing guidance on coverage policies. Each MAC may have specific instructions or local coverage determinations (LCDs) that affect whether CPT code 90630 is reimbursed. Therefore, it is advisable to check with your regional MAC for any specific coverage criteria or documentation requirements related to this code.
In summary, while CPT code 90630 may be listed in the MPFS, confirming its reimbursement status requires checking both the MPFS and any relevant MAC guidelines.
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