CPT code 90655 is a code used to identify a specific flu vaccine administered intramuscularly without preservatives.
CPT code 90655 is used to describe an influenza virus vaccine, specifically a trivalent formulation that does not contain preservatives. This vaccine is administered intramuscularly in a 0.25 mL dosage. It is typically used for immunizing children aged 6 months to 35 months against the flu. This code is essential for healthcare providers to accurately document and bill for the administration of this specific type of flu vaccine.
For CPT code 90655, which pertains to the administration of a specific vaccine, 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 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 a procedure or service was distinct or independent from other services performed on the same day. It may be applicable if multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same vaccine is administered more than once on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This is used if the same vaccine is administered more than once on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although typically used for lab tests, this modifier can sometimes be applicable if a vaccine administration is repeated for clinical reasons.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is supplied by the state and not billed to the patient or insurance.
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.
The CPT code 90655, which refers to a specific immunization, is subject to reimbursement by Medicare under certain conditions. To determine if Medicare reimburses this code, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, reimbursement can vary based on regional policies set by the Medicare Administrative Contractor (MAC) responsible for processing claims in a specific area. Each MAC may have specific guidelines or requirements for the reimbursement of immunization codes like 90655.
Therefore, it is crucial for providers to verify the coverage and reimbursement details with their respective MAC to ensure compliance and proper billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 90655, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
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