CPT code 90687 is a specific code used to identify the IIV4 vaccine, a 0.25 ml intramuscular injection for healthcare documentation.
CPT code 90687 is used to identify the administration of a quadrivalent influenza vaccine, specifically a split virus, intended for intramuscular use in a 0.25 mL dosage. This code is typically utilized for billing purposes when healthcare providers administer this particular type of flu vaccine, which is designed to protect against four different flu viruses. The 0.25 mL dosage is often used for pediatric patients, ensuring they receive the appropriate amount of vaccine for their age and size.
For CPT code 90687, which pertains to the administration of a specific vaccine, 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 addition to 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 the same physician or other qualified healthcare professional. This modifier is used if the same vaccine is administered more than once on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare 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 commonly used with vaccine administration, it may be applicable if the vaccine administration is part of a telehealth service.
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 help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90687 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including the associated payment rates.
However, the actual reimbursement for CPT code 90687 can vary based on the region and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that area. Each MAC may have its own local coverage determinations (LCDs) that can influence whether and how a particular service is reimbursed.
Therefore, healthcare providers should verify the coverage and reimbursement details with their respective MAC to ensure compliance and accurate billing.
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