CPT code 90649 is a code used to identify the 4vHPV vaccine administered in three doses via intramuscular injection.
CPT code 90649 is used to identify the administration of the quadrivalent human papillomavirus (HPV) vaccine, which is given in a three-dose series via intramuscular injection. This vaccine is designed to protect against four types of HPV, which are associated with various health issues, including cervical cancer and genital warts. The code is utilized by healthcare providers to accurately document and bill for the vaccine's administration in a clinical setting.
For CPT code 90649, which pertains to the administration of the 4-valent human papillomavirus (HPV) vaccine in a 3-dose schedule via intramuscular injection, the following modifiers may be applicable:
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 (E/M) 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 administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine administration is repeated 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 administration is repeated 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 used for vaccine administration, if any part of the service involves telemedicine, this modifier may be applicable.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied to the provider at no cost by the state.
These modifiers help clarify the circumstances under which the vaccine is administered and ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90649 is associated with the administration of a vaccine. When it comes to Medicare reimbursement, it's important to note that vaccines are generally covered under Medicare Part D, not Part B, which is where the Medicare Physician Fee Schedule (MPFS) primarily applies. However, certain vaccines may be covered under Part B if they are directly related to the treatment of an injury or direct exposure to a disease or condition.
For CPT code 90649, Medicare typically does not reimburse this code under the MPFS because it pertains to a vaccine that is not covered under Medicare Part B. Instead, coverage might be available through Medicare Part D plans, which are managed by private insurers. These plans have their own formularies and coverage rules, so reimbursement can vary.
To determine if a specific Medicare Administrative Contractor (MAC) provides any exceptions or specific guidance regarding this code, healthcare providers should consult the local coverage determinations (LCDs) or contact the MAC directly. This will provide the most accurate and up-to-date information regarding any potential reimbursement scenarios under Medicare.
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