CPT code 90672 is a code used to identify the Laiv4 vaccine administered intranasally, facilitating accurate documentation and reporting in healthcare.
CPT code 90672 is used to identify the administration of the quadrivalent live attenuated influenza vaccine (LAIV4) via the intranasal route. This vaccine is designed to protect against four different strains of the influenza virus, offering broader protection compared to trivalent vaccines. The intranasal administration is a needle-free option, often preferred for pediatric patients or those who have an aversion to injections. This code is essential for healthcare providers to accurately document and bill for the service of administering this specific type of flu vaccine.
For CPT code 90672, which pertains to the administration of the LAIV4 vaccine intranasally, 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 significant, separately identifiable E/M service is performed in conjunction with 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 a different session or encounter.
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. This modifier is generally not applicable to vaccine administration but could be relevant if the encounter includes telehealth services.
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 should be used in accordance with payer guidelines and specific clinical scenarios to ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer policies.
CPT code 90672 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for various services, including vaccines. However, the actual reimbursement for CPT code 90672 can vary based on the policies of the Medicare Administrative Contractor (MAC) that processes claims in a particular region. Each MAC may have specific guidelines regarding the coverage and reimbursement of vaccines, including any necessary documentation or conditions that must be met for payment. Therefore, healthcare providers should consult their local MAC's policies and the MPFS to ensure compliance and accurate reimbursement for CPT code 90672.
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