CPT code 90673 is a code used to identify the Riv3 vaccine without preservatives, facilitating accurate documentation and reimbursement processes.
CPT code 90673 is used to identify the administration of the RIV3 vaccine, which is a recombinant influenza vaccine that does not contain preservatives. This code is specifically utilized for billing purposes when a healthcare provider administers this type of flu vaccine to a patient. The absence of preservatives in the vaccine formulation is an important detail, as it may be relevant for patients with specific allergies or sensitivities. This code helps ensure accurate documentation and reimbursement for the vaccine administration within the healthcare revenue cycle.
For CPT code 90673, which pertains to the administration of a preservative-free vaccine, 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 multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by the same provider on the same day.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider on the same day.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although primarily used for laboratory tests, this modifier can sometimes be relevant if the vaccine administration is part of a repeated clinical diagnostic service.
6. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. This modifier is applicable if the vaccine administration is part of a telemedicine service.
7. Modifier 99: Multiple Modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90673 is associated with a specific vaccine and its reimbursement by Medicare can vary based on several factors. To determine if CPT code 90673 is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. Additionally, reimbursement can be influenced by local coverage determinations made by Medicare Administrative Contractors (MACs), which are responsible for processing claims and making coverage decisions in specific geographic regions.
Providers should verify the current status of CPT code 90673 on the MPFS and consult with their respective MAC to ensure compliance with any regional policies or guidelines. It's important to stay updated on any changes to Medicare coverage policies, as these can impact reimbursement eligibility for specific CPT codes.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 90673. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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