CPT code 90647 is a code used to identify the Hib PRP-OMP vaccine administered in three doses via intramuscular injection.
CPT code 90647 is used to identify the administration of the Haemophilus influenzae type b (Hib) vaccine, specifically the PRP-OMP (polyribosylribitol phosphate conjugated to an outer membrane protein) formulation. This vaccine is typically given in a three-dose series and is administered intramuscularly (IM). The Hib vaccine is crucial in preventing infections caused by the Haemophilus influenzae type b bacteria, which can lead to serious conditions such as meningitis, pneumonia, and epiglottitis, particularly in young children. This CPT code is used by healthcare providers to document and bill for the administration of this specific vaccine.
For CPT code 90647, which pertains to the administration of the Haemophilus influenzae type b (Hib) vaccine, 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 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 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 might be applicable in rare cases where the vaccine administration is repeated for clinical reasons.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the healthcare provider at no cost by the state.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90647, which is associated with a specific medical service, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a particular CPT code is reimbursable. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals under Medicare Part B.
For CPT code 90647, reimbursement eligibility is also influenced by the local coverage determinations (LCDs) set forth by the Medicare Administrative Contractors (MACs). MACs are responsible for processing Medicare claims and have the authority to establish specific coverage policies within their jurisdictions. Therefore, whether CPT code 90647 is reimbursed can vary based on the MAC's guidelines and the specific circumstances of the service provided.
Healthcare providers should consult the MPFS and their respective MAC's LCDs to verify the reimbursement status of CPT code 90647. This ensures compliance with Medicare's billing requirements and maximizes the likelihood of successful claim processing.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 90647, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
