CPT code 90633 is a code used to identify the administration of a two-dose hepatitis A vaccine for pediatric and adolescent patients.
CPT code 90633 is used to identify the administration of the hepatitis A vaccine for pediatric and adolescent patients, specifically for a two-dose schedule given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the vaccination service provided to children and teenagers, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90633, which pertains to the administration of the Hepatitis A vaccine for pediatric and adolescent patients in a 2-dose schedule via intramuscular injection, 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 administration is repeated 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 administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although not typically used for vaccine administration, this modifier might be relevant if the administration is part of a clinical study or trial requiring repeated testing.
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. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 90633, which is associated with a specific medical service, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, it's important to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide guidance on coverage specifics and any regional variations in reimbursement policies. The MAC can confirm whether CPT code 90633 is reimbursed in your area and under what conditions. Always ensure that the service meets Medicare's medical necessity criteria and documentation requirements to facilitate successful reimbursement.
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