CPT code 90671 is a specific code used to identify the PCV15 vaccine administered via injection in healthcare settings.
CPT code 90671 is used to identify the administration of the pneumococcal conjugate vaccine, specifically the 15-valent version, which is given via intramuscular injection. This vaccine is designed to protect against infections caused by 15 different strains of the bacterium Streptococcus pneumoniae, which can lead to serious illnesses such as pneumonia, meningitis, and bloodstream infections. The use of this code is essential for healthcare providers to accurately document and bill for the vaccine administration in their practice, ensuring proper reimbursement and maintaining accurate patient records.
For CPT code 90671, which pertains to the administration of the PCV15 vaccine 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 (E/M) 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 administration is performed in conjunction with other procedures that are not typically reported 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, which is uncommon but possible in specific clinical scenarios.
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 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 rare 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. Always verify with current payer policies and guidelines, as modifier requirements can vary.
CPT code 90671 is associated with the PCV15 vaccine administered intramuscularly. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for your region.
As of the latest updates, CPT code 90671 is generally covered under Medicare Part B, especially when administered to eligible beneficiaries who meet the criteria for pneumococcal vaccinations. The reimbursement rates and specific coverage details can vary based on the MPFS, which outlines the payment rates for services covered under Medicare Part B. Additionally, MACs, which are responsible for processing Medicare claims, may have specific local coverage determinations (LCDs) that influence the reimbursement process for this code.
Healthcare providers should verify the latest MPFS updates and consult their regional MAC for precise information on coverage and reimbursement for CPT code 90671 to ensure compliance and accurate billing.
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