CPT code 90634 is a code used to identify the administration of the hepatitis A vaccine for pediatric and adolescent patients in a three-dose series.
CPT code 90634 is used to identify the administration of the hepatitis A vaccine for pediatric and adolescent patients, specifically in a three-dose schedule. This code is utilized by healthcare providers to document and bill for the vaccination service provided to children and teenagers, ensuring they receive the necessary immunization against hepatitis A, a liver infection caused by the hepatitis A virus.
For CPT code 90634, which pertains to the administration of a pediatric/adolescent hepatitis A vaccine in a 3-dose schedule, 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 necessary if multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same vaccine is administered more than once on the same day due to specific medical necessity.
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. While not typically applicable to vaccine administration, if the counseling or evaluation related to the vaccine is conducted via telemedicine, this modifier might be used.
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 about the services rendered. It is important to verify payer-specific guidelines, as the use of modifiers can vary based on the insurance provider's policies.
CPT code 90634 is associated with a specific vaccination and its reimbursement by Medicare can be determined by consulting the Medicare Physician Fee Schedule (MPFS) and the policies of the relevant Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates. However, it's important to note that not all CPT codes are reimbursed by Medicare, especially those related to preventive services like vaccinations, which may fall under different coverage rules.
For CPT code 90634, Medicare coverage and reimbursement can vary based on the specific circumstances and the MAC's local coverage determinations. Typically, vaccines for pediatric and adolescent populations are not covered under Medicare Part B, as Medicare primarily serves individuals aged 65 and older, along with certain younger individuals with disabilities. However, if the vaccine is administered to a Medicare beneficiary who meets specific criteria under Medicare Part D, it might be covered.
Healthcare providers should verify the reimbursement status of CPT code 90634 by consulting the MPFS and contacting their local MAC for the most accurate and up-to-date information. This ensures compliance with Medicare's billing requirements and helps in understanding any potential coverage limitations or conditions.
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