CPT code 90656 is a code used to identify the administration of a specific flu vaccine without preservatives, given via injection.
CPT code 90656 is used to identify the administration of an influenza virus vaccine, specifically a trivalent formulation that does not contain preservatives. This vaccine is provided in a 0.5 milliliter dosage and is administered via intramuscular injection. This code is typically used by healthcare providers to document and bill for the flu vaccine given to patients, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90656, which pertains to the administration of the influenza virus vaccine, trivalent (IIV3), preservative-free, for intramuscular use, 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 significant, separately identifiable evaluation and management (E/M) service is performed by the same physician 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 procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by the same provider. It may be applicable if the vaccine is administered more than once on the same day due to special circumstances.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider. It may be applicable if the 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 laboratory tests, this modifier may be applicable in rare cases where the vaccine administration is repeated for clinical reasons.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for the use of modifiers.
The CPT code 90656 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates, while the MACs administer Medicare claims and can offer guidance on local coverage determinations and any specific billing requirements.
It is advisable for healthcare providers to consult these resources to ensure accurate billing and reimbursement for CPT code 90656.
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