CPT code 90689 is a code used to identify a specific vaccine, indicating it is a 0.25ml intramuscular injection without preservatives.
CPT code 90689 is used to identify the administration of an influenza vaccine, specifically a quadrivalent inactivated influenza vaccine (IIV4) that does not contain preservatives. This vaccine is administered intramuscularly in a 0.25 mL dosage. Quadrivalent vaccines are designed to protect against four different flu viruses, providing broader protection compared to trivalent vaccines. This particular code is crucial for healthcare providers to accurately document and bill for the administration of this specific type of flu vaccine.
For CPT code 90689, which pertains to a vaccine administration, 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 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 when the same procedure is repeated by the same provider. It might be applicable if multiple doses of the vaccine are administered on the same day.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider. It might be applicable if the vaccine is administered by a different healthcare professional on the same day.
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 service involves telemedicine components, although this is less common for vaccine administration.
6. Modifier 99: Multiple Modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple modifiers apply to the procedure.
These modifiers should be used in accordance with payer guidelines and specific clinical scenarios to ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer policies, as requirements can vary.
CPT code 90689 is associated with a specific vaccination and its reimbursement by Medicare is determined by several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) in your region.
To determine if CPT code 90689 is reimbursed by Medicare, healthcare providers should first consult the MPFS, which outlines the payment rates for services covered under Medicare Part B. The MPFS is updated annually and provides detailed information on whether a particular service, such as the one associated with CPT code 90689, is covered and at what rate.
Additionally, it is crucial to check with the local MAC, as they have the authority to make coverage decisions and provide guidance on billing and reimbursement for services in their jurisdiction. MACs may have specific Local Coverage Determinations (LCDs) that affect whether CPT code 90689 is reimbursed.
In summary, while the MPFS and MACs play a pivotal role in determining the reimbursement status of CPT code 90689, healthcare providers should verify the most current information through these resources to ensure accurate billing and reimbursement practices.
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