CPT code 90653 is a code used to identify the administration of an influenza vaccine that includes an adjuvant to enhance the immune response.
CPT code 90653 is used to identify the administration of an influenza virus vaccine that is adjuvanted and given via intramuscular injection. This code is specifically for the flu vaccine that includes an adjuvant, which is an ingredient added to the vaccine to help create a stronger immune response in the patient. Healthcare providers use this code for billing and documentation purposes when they administer this particular type of flu vaccine.
For CPT code 90653, which pertains to the administration of an influenza vaccine with an adjuvant, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. Use this modifier if a significant, separately identifiable evaluation and management service is performed in addition to the vaccine administration.
2. Modifier 59: Distinct Procedural Service. This modifier may be used if the vaccine administration is distinct or independent from other services provided on the same day.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Use this modifier 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 Health Care Professional. This modifier is applicable 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. Although not commonly used for vaccine administration, if the service includes telemedicine components, this modifier might be applicable.
6. Modifier 99: Multiple Modifiers. Use this modifier when two or more modifiers are necessary to describe the service provided.
These modifiers should be applied based on the specific context of the service and the payer's guidelines. Always ensure compliance with the latest coding standards and payer-specific requirements when using modifiers.
The CPT code 90653 is reimbursed by Medicare, but its reimbursement is subject to specific conditions outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the payment rates for each service. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and make coverage decisions within their jurisdiction, which can affect whether and how much a provider is reimbursed for CPT code 90653. Therefore, it is essential for healthcare providers to verify the specific coverage and reimbursement details with their respective MAC to ensure compliance and accurate billing.
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