CPT code 90686 is a code used to identify the administration of the IIV4 vaccine without preservatives, given as a 0.5 ml intramuscular injection.
CPT code 90686 is used to identify the administration of an influenza vaccine, specifically the quadrivalent formulation, which contains no preservatives. This vaccine is provided in a 0.5 mL dosage and is administered via intramuscular injection. The quadrivalent vaccine is designed to protect against four different flu viruses, offering broader protection compared to trivalent vaccines. This code is essential for healthcare providers to accurately document and bill for the immunization service provided to patients.
For CPT code 90686, which pertains to the administration of the influenza vaccine, the following modifiers may be applicable depending on the specific circumstances of the service provided:
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 patient receives a significant, separately identifiable evaluation and management (E/M) service 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 if the same 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 Health Care Professional. This modifier is used if the same 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, if any part of the service involves telemedicine, this modifier might be relevant.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied by the state and not billed to the patient or insurance.
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 usage can vary.
CPT code 90686 is reimbursed by Medicare, as it pertains to a service that is typically covered under preventive care.
To determine the reimbursement specifics for CPT 90686, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, reimbursement can vary slightly based on geographic location and other factors, so it is crucial to consult with the local Medicare Administrative Contractor (MAC) for precise details regarding coverage and payment rates for this specific CPT code.
The MAC is responsible for processing Medicare claims and can provide guidance on any regional variations in reimbursement policies.
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