CPT code 90669 is a code used to identify the pneumococcal vaccine that protects against seven types of bacteria when administered via injection.
CPT code 90669 is used to identify the administration of the pneumococcal conjugate vaccine, specifically the 7-valent formulation, which is given via intramuscular injection. This vaccine is designed to protect against infections caused by seven different strains of the bacterium Streptococcus pneumoniae, which can lead to serious illnesses such as pneumonia, meningitis, and sepsis. The code is utilized by healthcare providers to accurately document and bill for the vaccine's administration in a clinical setting.
For CPT code 90669, which pertains to the pneumococcal vaccine, 7-valent, administered intramuscularly, 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 the vaccine is administered in conjunction with other services that are not typically performed together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care 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 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. Although not typically used for vaccines, this modifier may be applicable if the vaccine administration is repeated for clinical reasons.
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 for the services rendered. It is important to verify payer-specific guidelines, as modifier requirements can vary.
CPT code 90669 is associated with the pneumococcal vaccine, specifically the 7-valent formulation administered intramuscularly. When considering whether this CPT code is reimbursed by Medicare, it's important to refer to the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the Medicare Administrative Contractors (MACs).
Medicare Part B typically covers pneumococcal vaccines, but coverage can vary based on the specific formulation and the guidelines in place at the time of service. As of the latest updates, CPT code 90669 is not commonly reimbursed by Medicare because the 7-valent pneumococcal vaccine has largely been replaced by newer formulations, such as the 13-valent and 23-valent vaccines, which are more widely covered.
Healthcare providers should verify the current status of reimbursement for CPT code 90669 by consulting the MPFS and checking with their specific MAC, as these entities provide the most up-to-date information on coverage and reimbursement policies. Additionally, providers should ensure they are using the most current and appropriate CPT codes for pneumococcal vaccinations to align with Medicare's coverage criteria.
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