CPT code 90664 is a code used to identify the intranasal pandemic vaccine for healthcare providers, ensuring accurate documentation and reimbursement.
CPT code 90664 is used to identify the administration of a live attenuated influenza vaccine (LAIV) specifically designed for pandemic situations, delivered via the intranasal route. This code is utilized by healthcare providers to document and bill for the administration of this type of vaccine, which is typically used during a pandemic outbreak to help control the spread of influenza. The intranasal delivery method is a needle-free option, often preferred for its ease of administration, especially in pediatric and needle-averse populations.
For CPT code 90664, which pertains to the administration of a pandemic intranasal 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 evaluation and management service is provided by the same healthcare provider 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 necessary 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 the same physician or other qualified healthcare professional. This modifier is used if the 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 healthcare 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. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
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's important for healthcare providers to use the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
The CPT code 90664, which is associated with a specific service, is not reimbursed by Medicare. This determination is based on the Medicare Physician Fee Schedule (MPFS), which outlines the services covered and reimbursed by Medicare.
Additionally, Medicare Administrative Contractors (MACs), who are responsible for processing claims and making coverage decisions, do not include CPT code 90664 in their list of reimbursable services.
Therefore, healthcare providers should be aware that claims submitted to Medicare for this particular code will not be reimbursed.
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