CPT code 90691 is a specific code used to identify the Typhoid vaccine administered via injection in healthcare settings.
CPT code 90691 is used to identify the administration of the typhoid vaccine given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the service of administering this specific vaccine, which is designed to protect against typhoid fever—a serious illness caused by the bacterium Salmonella Typhi. Proper use of this code ensures accurate reimbursement and helps maintain comprehensive patient immunization records.
For CPT code 90691, which pertains to the administration of the typhoid vaccine via intramuscular injection, 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 patient receives a vaccine and also has a separate evaluation and management service on the same day.
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 the same physician or other qualified healthcare professional. This modifier is used if the 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 healthcare professional. This modifier is used if the vaccine is administered more than once on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for vaccines, this modifier might be applicable in rare cases where a repeat test is necessary for the same patient on the same day.
These modifiers help clarify the circumstances under which the vaccine was administered and ensure accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier requirements can vary.
The CPT code 90691, which is associated with the typhoid vaccine administered intramuscularly, is not reimbursed by Medicare. According to the Medicare Physician Fee Schedule (MPFS), certain vaccines, including the typhoid vaccine, are not covered under Medicare Part B. Coverage for vaccines under Medicare is typically limited to those that are directly related to preventive services, such as influenza, pneumococcal, and hepatitis B vaccines.
For any specific inquiries regarding coverage, healthcare providers should consult their respective Medicare Administrative Contractor (MAC) for guidance. MACs are responsible for processing Medicare claims and can provide detailed information on coverage determinations and any potential exceptions or updates to reimbursement policies.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 90691. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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