CPT code 90688 is a code used to identify the IIV4 vaccine, a 0.5 ml intramuscular injection for flu prevention.
CPT code 90688 is used to identify the administration of the influenza virus vaccine, specifically the quadrivalent (IIV4) formulation. This vaccine is split-virus and is administered in a 0.5 mL dosage via intramuscular injection. The quadrivalent vaccine is designed to protect against four different flu viruses, providing broader protection compared to the trivalent version. This code is essential for healthcare providers to accurately document and bill for the administration of this specific flu vaccine.
For the CPT code 90688, which pertains to the administration of the influenza 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 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. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccines.
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 to the services rendered. Always verify payer-specific guidelines, as they may have unique requirements for modifier usage.
The CPT code 90688 is reimbursed by Medicare, as it pertains to a preventive service that is generally covered under Medicare Part B. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
However, the specific reimbursement rate for CPT code 90688 can vary depending on the geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and setting payment rates within their jurisdiction, ensuring that providers receive appropriate reimbursement for the services rendered.
Therefore, healthcare providers should consult their respective MAC for the most accurate and up-to-date reimbursement information for CPT code 90688.
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