CPT code 90648 is a code used to identify the Hib PRP-T vaccine, which is administered in four doses via intramuscular injection.
CPT code 90648 is used to identify the administration of the Haemophilus influenzae type b (Hib) vaccine, specifically the PRP-T (polyribosylribitol phosphate-tetanus toxoid conjugate) formulation. This vaccine is typically given in a series of four doses 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 code is used by healthcare providers to ensure accurate billing and documentation for the vaccine's administration.
For CPT code 90648, which pertains to the administration of the Hib PRP-T vaccine in a 4-dose intramuscular series, the following modifiers may be applicable:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional 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 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 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 same vaccine is administered more than once on the same day by a different provider due to specific medical necessity.
5. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Although not commonly used for vaccine administration, this modifier may be applicable if the vaccine administration is part of a telehealth service where counseling or other services are provided remotely.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is provided to the provider at no cost by the state.
Each modifier should be used according to the specific circumstances of the service provided and in compliance with payer policies. It is important to ensure that documentation supports the use of any modifier applied to the CPT code.
The CPT code 90648, which is associated with a specific medical service, is reimbursed by Medicare under certain conditions. To determine if this code is reimbursed, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare. Additionally, reimbursement can vary based on the guidelines set by the Medicare Administrative Contractor (MAC) in your specific region, as MACs are responsible for processing Medicare claims and can have localized policies. It is essential for providers to verify the coverage and reimbursement details with their respective MAC to ensure compliance and accurate billing.
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