CPT code 90654 is a code used to identify a specific flu vaccine, indicating it is preservative-free and for intramuscular use.
CPT code 90654 is used to identify the administration of an influenza vaccine, specifically the trivalent inactivated influenza vaccine (IIV3) that is preservative-free and administered intradermally. This code is utilized by healthcare providers to document and bill for the delivery of this specific type of flu vaccine, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90654, which pertains to the influenza vaccine, intradermal, preservative-free, there are no specific modifiers that are universally required. However, there are general modifiers that could potentially be used in certain situations depending on the context of the service provided. Here is a list of possible modifiers that might 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 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 is used to indicate that a procedure or service was distinct or independent from other services performed 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 same procedure 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 same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for vaccines, this modifier is used when a laboratory test is repeated on the same day to obtain subsequent results.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration is part of a telemedicine service.
It is important to note that the use of modifiers should be guided by payer-specific policies and the clinical context of the service provided. Always verify with the specific payer to ensure compliance with their billing requirements.
CPT code 90654, which is associated with a specific service, is subject to reimbursement 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 forth by the Medicare Administrative Contractor (MAC) for the provider's specific region. MACs are responsible for processing Medicare claims and can provide detailed information on coverage and reimbursement policies for CPT code 90654.
It is essential for providers to verify with their local MAC to ensure compliance with any regional variations in coverage.
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