CPT code 90670 is a code used to identify the PCV13 vaccine for immunization against pneumococcal disease in healthcare settings.
CPT code 90670 is used to identify the administration of the pneumococcal conjugate vaccine, 13-valent (PCV13), given via intramuscular injection. This vaccine is designed to protect against 13 types of pneumococcal bacteria, which can cause serious infections such as pneumonia, meningitis, and bacteremia. The code is utilized by healthcare providers for billing and documentation purposes to ensure accurate reimbursement for the vaccine administration.
For CPT code 90670, which pertains to the administration of the PCV13 vaccine, 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 counseling or related services are provided via telemedicine.
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 about the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90670 is reimbursed by Medicare under specific conditions. This code is included in the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services and procedures covered by Medicare. However, the reimbursement for CPT code 90670 may vary based on the guidelines set forth by the Medicare Administrative Contractor (MAC) in your region. MACs are responsible for processing Medicare claims and have the authority to determine coverage and payment policies within their jurisdiction. Therefore, it is essential for healthcare providers to verify the specific reimbursement criteria and any potential local coverage determinations (LCDs) related to CPT code 90670 with their respective MAC.
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