CPT code 90646 is a specific code used to identify the Hib vaccine (prp-d) administered via injection.
CPT code 90646 is used to identify the administration of the Haemophilus influenzae type b (Hib) vaccine, specifically the PRP-D (polyribosylribitol phosphate-diphtheria toxoid conjugate) formulation, given via intramuscular injection. This vaccine is crucial in preventing infections caused by the Hib bacteria, which can lead to serious conditions such as meningitis, pneumonia, and epiglottitis, particularly in young children. The code is used by healthcare providers to document and bill for the administration of this specific vaccine in clinical settings.
For CPT code 90646, which pertains to the administration of the Hib vaccine (PRP-D) intramuscularly, 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 administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same 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 healthcare professional. This modifier is used if the same vaccine is administered more than once on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for vaccines, this modifier may be applicable if the vaccine administration is part of a series of tests or procedures that need to be repeated for clinical reasons.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is supplied by the state and is not billed to the patient or insurance.
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 90646, which pertains to a specific service, is subject to reimbursement considerations under Medicare. To determine if Medicare reimburses this code, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the relevant Medicare Administrative Contractor (MAC) for your region. The MPFS outlines the payment rates for services covered by Medicare, while MACs administer Medicare claims and provide guidance on coverage specifics. It is important to verify with the MAC in your jurisdiction to confirm if CPT code 90646 is reimbursed, as coverage can vary based on local policies and specific circumstances.
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