CPT code 90645 is a specific code used to identify the Hib vaccine administered via intramuscular injection.
CPT code 90645 is used to identify the administration of the Haemophilus influenzae type b (Hib) vaccine, specifically the HbOC (Hib oligosaccharide conjugate) formulation, given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the immunization service provided to protect against infections caused by the Hib bacteria, which can lead to serious conditions such as meningitis and pneumonia.
For CPT code 90645, which pertains to the Hib vaccine administered intramuscularly, the following modifiers may be applicable depending on the specific circumstances of the service provided:
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 is administered in conjunction with other procedures that are not typically performed together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine is administered more than once 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 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. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
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 provide additional information about the circumstances under which the vaccine was administered, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90645, which is associated with the Hib vaccine hboc im, is subject to reimbursement by Medicare, but this depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining whether a specific CPT code is reimbursed by Medicare. The MPFS outlines the payment rates for services and procedures covered under Medicare Part B, including vaccines.
However, it's important to note that the reimbursement for CPT code 90645 can also be influenced by the policies of the Medicare Administrative Contractor (MAC) that serves your geographic region. MACs are responsible for processing Medicare claims and have the authority to make local coverage determinations (LCDs) that can affect whether a particular service or procedure is reimbursed.
Healthcare providers should consult the MPFS and their respective MAC's guidelines to confirm the reimbursement status of CPT code 90645. Additionally, it's advisable to verify any specific coverage criteria or documentation requirements that may apply to ensure proper reimbursement.
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