CPT code 90680 is a code used to identify the administration of the Rv5 vaccine, which is a three-dose live oral vaccine for rotavirus.
CPT code 90680 is used to identify the administration of the rotavirus vaccine, specifically the RotaTeq vaccine, which is a live, oral vaccine given in a three-dose series. This vaccine is designed to protect infants and young children from rotavirus infections, which can cause severe diarrhea and dehydration. The code is utilized by healthcare providers to accurately document and bill for the administration of this particular vaccine in a clinical setting.
For CPT code 90680, which pertains to the administration of the rotavirus vaccine, live, for oral use, 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 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 unlikely for this particular vaccine but could be applicable in rare circumstances.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. Similar to Modifier 76, this 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 applicable to vaccine administration, this modifier could be used 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 supplied to the provider at no cost by the state.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90680 is associated with a vaccine, and its reimbursement 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) in your region. Generally, vaccines are covered under Medicare Part D, but certain vaccines may also be covered under Part B if they are directly related to the treatment of an injury or direct exposure to a disease or condition.
To determine if CPT code 90680 is reimbursed by Medicare, healthcare providers should consult the MPFS to see if the code is listed and check with their local MAC for any specific coverage policies or requirements. Additionally, providers should verify if the vaccine is covered under the patient's Medicare Part D plan, as this can vary based on the plan's formulary and coverage rules.
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