CPT code 90658 is a code used to identify the administration of the IIV3 vaccine, specifically a 0.5 ml intramuscular injection.
CPT code 90658 is used to describe the administration of the trivalent influenza vaccine, which is a split-virus vaccine given in a 0.5 ml dose via intramuscular injection. This code is specifically utilized for billing purposes when healthcare providers administer this type of flu vaccine to patients. The trivalent formulation typically includes three strains of the influenza virus, selected based on predictions of which strains will be most prevalent during the upcoming flu season. This code helps ensure accurate documentation and reimbursement for the vaccine's administration in a clinical setting.
For CPT code 90658, which pertains to the administration of the influenza virus vaccine, trivalent (IIV3), split virus, 0.5 ml, intramuscular, 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 if the vaccine is administered more than once on the same day by the same provider, which is uncommon but possible in certain clinical scenarios.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used 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. While typically not applicable to vaccine administration, this modifier might be relevant if the vaccine administration is part of a telehealth visit where counseling or other services are provided.
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 for the services rendered. It's important to verify payer-specific guidelines, as the applicability of modifiers can vary.
CPT code 90658, which is associated with a specific medical service, is generally reimbursed by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates. However, the actual reimbursement can vary based on the geographical location and specific policies set by the Medicare Administrative Contractor (MAC) responsible for that region.
Each MAC has the authority to interpret national Medicare policies and may have additional local coverage determinations that affect whether and how a particular CPT code, such as 90658, is reimbursed. Therefore, healthcare providers should verify with their local MAC to ensure that CPT code 90658 is covered and understand any specific billing requirements or limitations that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and pinpointing underpayments down to the CPT code level, including specific codes like 90658. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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