CPT code 90650 is a code used to identify the administration of the 2vhpv vaccine in a three-dose series via intramuscular injection.
CPT code 90650 is used to identify the administration of the human papillomavirus (HPV) vaccine, specifically the quadrivalent vaccine that targets four HPV types. This vaccine is given in a three-dose series and is administered via intramuscular injection. The quadrivalent HPV vaccine is designed to protect against certain strains of HPV that are known to cause cervical cancer and other HPV-related diseases. This code is essential for healthcare providers to accurately bill and receive reimbursement for the vaccine administration from insurance companies and other payers.
For CPT code 90650, which pertains to the administration of the HPV vaccine, 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 patient receives a vaccine and also has a separate evaluation and management service on the same day.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the vaccine administration is distinct or independent from other services provided on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used if the 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 is used when 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 if the vaccine administration is part of a series of tests or procedures that need to be repeated.
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 to the services rendered. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 90650, which pertains to a specific medical service, is subject to reimbursement considerations under Medicare. However, it's important to note that Medicare typically does not cover routine immunizations for adults, except for certain vaccines like influenza, pneumococcal, and hepatitis B for high-risk individuals. Therefore, CPT code 90650 is generally not reimbursed by Medicare under the Medicare Physician Fee Schedule (MPFS).
For healthcare providers seeking reimbursement information, it's crucial to consult with their respective Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies, including any exceptions or special circumstances that might apply to CPT code 90650. Always verify with the MAC to ensure the most accurate and up-to-date information regarding Medicare reimbursement for this code.
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