CPT code 90632 is a code used to identify the administration of the Hepatitis A vaccine for adults in healthcare settings.
CPT code 90632 is used to identify the administration of the Hepatitis A vaccine for adults via intramuscular injection. This code is specifically utilized in medical billing to denote the provision of this particular vaccine, ensuring that healthcare providers can accurately document and receive reimbursement for the immunization service provided to adult patients.
For CPT code 90632, which pertains to the administration of the Hepatitis A vaccine for adults via intramuscular injection, 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 when a significant, separately identifiable E/M service is performed 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 necessary if multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the vaccine needs to be administered again within a short period due to specific clinical circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the vaccine is administered again by a different provider within a short period.
5. Modifier 91: Repeat clinical diagnostic laboratory test. While not typically used for vaccines, this modifier might be relevant if the vaccine administration is part of a broader diagnostic process requiring repetition.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is applicable if the vaccine administration is part of a telehealth service, although direct administration would not occur via telehealth.
7. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to apply them correctly to avoid claim denials or delays.
CPT code 90632, which is associated with a specific service, is generally reimbursed by Medicare, but several factors influence this reimbursement. The Medicare Physician Fee Schedule (MPFS) is a critical resource that determines the reimbursement rates for services covered under Medicare Part B. To ascertain if CPT code 90632 is reimbursed, healthcare providers should consult the MPFS to verify its inclusion and the associated payment rate.
Additionally, Medicare Administrative Contractors (MACs) play a significant role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on coverage policies and local coverage determinations (LCDs) that may affect the reimbursement of CPT code 90632. Providers should check with their specific MAC to ensure compliance with any regional policies or requirements that could impact reimbursement.
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