CPT code 90651 is a specific code used to identify the 2/3 dose of the HPV vaccine administered via intramuscular injection.
CPT code 90651 is used to identify the administration of the human papillomavirus (HPV) vaccine, specifically the 9-valent HPV vaccine, which is given either as a two-dose or three-dose series via intramuscular injection. This vaccine is designed to protect against nine different strains of HPV, which are associated with various cancers 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 90651, which pertains to the 9-valent human papillomavirus (HPV) vaccine administered intramuscularly in a 2- or 3-dose schedule, 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 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 services 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, which is uncommon but possible in specific clinical scenarios.
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 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. While not typically used for vaccine administration, this modifier may be relevant if the vaccine counseling or related services are provided via telemedicine.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the provider at no cost by the state or other governmental entity.
These modifiers should be used based on the specific circumstances of the vaccine administration and any additional services provided on the same day. Proper documentation is essential to support the use of any modifiers.
CPT code 90651 is associated with the 9vhpv vaccine, which is typically administered in a 2 or 3 dose schedule via intramuscular injection. When it comes to Medicare reimbursement, it's important to note that vaccines are generally covered under Medicare Part D, rather than 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 90651, Medicare coverage can vary based on specific circumstances and the determination of the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing claims and have the authority to make local coverage determinations. Therefore, it is crucial for healthcare providers to verify with their local MAC regarding the coverage and reimbursement specifics for this vaccine under Medicare.
In summary, while CPT code 90651 may not be reimbursed under the traditional MPFS, it could potentially be covered under Medicare Part D or in specific situations under Part B, subject to MAC guidelines. Providers should consult with their MAC for precise coverage details.
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