CPT code 90661 is a specific code used to identify the Cciiv3 vaccine administered via intramuscular injection.
CPT code 90661 is used to identify the administration of a preservative-free influenza vaccine, specifically the cell-cultured inactivated influenza vaccine (ccIIV3), in a 0.5 mL dosage given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the delivery of this particular type of flu vaccine, ensuring accurate reimbursement and record-keeping in the healthcare revenue cycle.
For CPT code 90661, which pertains to the administration of a 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 91: Repeat Clinical Diagnostic Laboratory Test. Although not typically used for vaccines, this modifier could be relevant if the vaccine administration is part of a clinical study requiring repeated administration for testing purposes.
6. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. This modifier is used if the vaccine administration is part of a telemedicine service, although direct administration would not typically involve telemedicine.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90661 is associated with a specific vaccine and its reimbursement by Medicare can be determined by consulting the Medicare Physician Fee Schedule (MPFS) and the guidance provided by the Medicare Administrative Contractor (MAC) for your region. The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. It is essential to verify whether CPT code 90661 is included in the MPFS and if it is covered under Medicare Part B or any other applicable part of Medicare.
Additionally, MACs, which are private organizations contracted by Medicare, play a crucial role in processing claims and providing coverage determinations. They may have specific Local Coverage Determinations (LCDs) that affect whether a particular service or procedure, such as the one associated with CPT code 90661, is reimbursed. Therefore, healthcare providers should consult their regional MAC for the most accurate and up-to-date information regarding the reimbursement status of CPT code 90661 under Medicare.
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