CPT code 90681 is a code used to identify the administration of the Rv1 vaccine, which is given in two doses as a live oral vaccine.
CPT code 90681 is used to identify the administration of the rotavirus vaccine, specifically the live, oral, two-dose formulation. 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 document and bill for the delivery of this particular vaccine as part of a child's immunization schedule.
For CPT code 90681, which pertains to the administration of the rotavirus vaccine (2-dose schedule, live, oral), 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, although this is uncommon for vaccines.
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, which is also uncommon for vaccines.
5. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. While not typically applicable to vaccine administration, if any part of the service involves telemedicine, this modifier may be used.
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 about the services rendered. It is important to review payer-specific guidelines, as modifier requirements can vary.
CPT code 90681, which is associated with a specific medical service, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 90681 is reimbursed in a particular area. Providers should consult their local MAC for the most accurate and up-to-date information regarding the reimbursement status of this code.
In summary, while the MPFS offers a general framework for Medicare reimbursement, the final determination often depends on the policies of the local MAC. Therefore, healthcare providers should verify with their MAC to ensure accurate billing and reimbursement for CPT code 90681.
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