CPT code 90659 is a specific code used to identify the flu vaccine for immunization purposes in healthcare settings.
CPT code 90659 is used to identify the administration of a whole-virus influenza vaccine given via intramuscular injection. This code is specifically designated for billing purposes when healthcare providers administer this type of flu vaccine to patients. It helps in accurately documenting the service provided, ensuring proper reimbursement from insurance companies, and maintaining organized medical records.
For CPT code 90659, which pertains to the administration of the flu 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 if a significant, separately identifiable E/M service is provided in addition to the vaccine administration.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the vaccine administration is 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 vaccine administration 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 vaccine administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. While not typically used for vaccines, this modifier can be relevant if the vaccine administration is part of a series of tests or procedures that need to be repeated.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is applicable if the vaccine administration is part of a telemedicine service, although this is less common for vaccines.
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 modifier usage can vary.
CPT code 90659 is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), this particular code is not listed for reimbursement. Medicare typically covers influenza vaccines under specific codes that align with their coverage policies. Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage specifics, do not include CPT code 90659 in their list of reimbursable services. Healthcare providers should verify the appropriate CPT codes that are covered for influenza vaccinations under Medicare to ensure proper billing and reimbursement.
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