CPT code 90644 is a specific code used to identify the Hib meningitis vaccine for infants aged 6 weeks to 18 months.
CPT code 90644 is used to identify the administration of a combination vaccine that protects against Haemophilus influenzae type b (Hib) and meningococcal disease. This vaccine is specifically designed for infants and young children aged 6 weeks to 18 months and is administered via intramuscular injection. The use of this code helps healthcare providers accurately document and bill for the vaccination service provided, ensuring proper reimbursement and maintaining precise medical records.
For the CPT code 90644, which pertains to the Hib-MenCY vaccine administered intramuscularly to patients aged 6 weeks to 18 months, 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 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 needs to be administered again on the same day due to specific circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This is used when the vaccine is administered again 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, this modifier could be relevant if the vaccine administration is part of a telehealth service where the provider is guiding the administration remotely.
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 for the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90644, which refers to a specific vaccination, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.
Additionally, it is crucial to check with the local Medicare Administrative Contractor (MAC), as they are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement for CPT code 90644. MACs may have local coverage determinations (LCDs) that affect whether a particular service is reimbursed in their jurisdiction. Therefore, while the MPFS offers a general framework, the MACs provide the final determination on reimbursement for specific CPT codes like 90644.
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