CPT code 90657 is a code used to identify the IIV3 vaccine, a 0.25 ml intramuscular injection for immunization purposes.
CPT code 90657 is used to identify the administration of an influenza virus vaccine, specifically a trivalent (IIV3) formulation. This code is applicable when the vaccine is given as a split virus and is administered intramuscularly (IM) in a 0.25 ml dosage. This particular dosage is typically used for pediatric patients, as it is a smaller volume suitable for young children. The use of this code helps healthcare providers accurately document and bill for the administration of this specific type of flu vaccine.
For CPT code 90657, 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 on the Same Day of the Procedure or Other Service. This modifier is used when a significant, separately identifiable evaluation and management 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 multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same 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 used if the same 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. This modifier is used 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 supplied by the state, indicating that the provider did not incur the cost of the vaccine.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90657 is associated with the administration of a specific vaccine. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
As of the latest updates, CPT code 90657 is generally not reimbursed by Medicare Part B because it pertains to a vaccine that is typically covered under Medicare Part D, the prescription drug benefit. Medicare Part B primarily covers vaccines such as influenza, pneumococcal, and hepatitis B for certain at-risk populations. However, coverage can vary based on specific circumstances and regional MAC guidelines.
Healthcare providers should verify the reimbursement status of CPT code 90657 by consulting the MPFS and checking with their local MAC for any specific coverage determinations or updates. Additionally, providers may need to explore Medicare Part D plans for potential coverage options for this vaccine.
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