CPT code 90667 is a specific code used to identify the administration of a pandemic influenza vaccine with an adjuvant.
CPT code 90667 is used to identify the administration of an influenza virus vaccine that is specifically formulated for a pandemic situation and includes an adjuvant. An adjuvant is a substance that is added to the vaccine to enhance the body's immune response to the vaccine. This code is utilized by healthcare providers to document and bill for the administration of this particular type of influenza vaccine during a pandemic, ensuring accurate reimbursement and record-keeping in the healthcare revenue cycle.
For CPT code 90667, which pertains to an influenza vaccine with an adjuvant, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when a patient receives a vaccine and also has a separate evaluation and management service on the same day.
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 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. While not typically used for vaccine administration, this modifier could be relevant if the vaccine administration is part of a telehealth service where counseling or other services are provided.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the provider at no cost by the state.
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 they may have unique requirements for modifier usage.
CPT code 90667, which is associated with a specific medical service, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies, including reimbursement decisions for specific CPT codes like 90667. Providers should consult their regional MAC for guidance on whether CPT code 90667 is reimbursed and any specific billing requirements or limitations that may apply.
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