CPT code 90665 is a specific code used to identify the Lyme disease vaccine for immunization purposes in healthcare settings.
CPT code 90665 is used to identify the administration of a Lyme disease vaccine given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the specific service of providing a vaccine that helps protect against Lyme disease, which is caused by the bacterium Borrelia burgdorferi and transmitted through tick bites. The use of this code ensures accurate tracking and reimbursement for the vaccination service provided.
The CPT code 90665 for the Lyme disease vaccine administered intramuscularly may require the use of modifiers under certain circumstances. Here is a list of potential modifiers that could 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. Use this modifier if a significant, separately identifiable evaluation and management service is performed 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 is administered in conjunction with other procedures that are not typically performed together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Use this modifier 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 vaccine is administered more than once on the same day by a different provider.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. While not typically used for vaccines, this modifier could be applicable if the vaccine administration is part of a repeated diagnostic process.
6. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. This modifier is generally not applicable to vaccine administration but could be relevant if the vaccine is part of a telehealth consultation.
These modifiers should be used based on the specific circumstances of the service provided and in accordance with payer policies and guidelines. Always verify with the specific payer to ensure correct usage and reimbursement.
CPT code 90665, which pertains to a specific service, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not include this code, indicating that it is not covered for reimbursement under Medicare Part B. Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage at the regional level, do not provide reimbursement for this particular CPT code. Therefore, healthcare providers should be aware that services billed under CPT code 90665 will not receive payment from Medicare.
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