CPT code 90693 is a specific code used to identify the Typhoid vaccine administered via subcutaneous injection.
CPT code 90693 is used to identify the administration of the typhoid vaccine, specifically the attenuated live oral form. This code is utilized by healthcare providers to document and bill for the vaccination service provided to protect against typhoid fever, a bacterial infection caused by Salmonella typhi. The code ensures accurate tracking and reimbursement for the vaccine administration within the healthcare revenue cycle.
For CPT code 90693, which pertains to the administration of the typhoid 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. Use this modifier if a significant, separately identifiable evaluation and management service is performed by the same provider 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 a different session or encounter.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. Use this modifier 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 applicable if the 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. If the vaccine administration is part of a telemedicine service, this modifier may be used to indicate the service was provided via telehealth.
6. Modifier 99: Multiple Modifiers. Use this modifier when two or more modifiers are necessary to describe the service provided.
These modifiers help clarify the circumstances under which the vaccine was administered and ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90693 is associated with the typhoid vaccine administered via the subcutaneous route. When determining if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by the Medicare Administrative Contractor (MAC) specific to your region.
As of the latest updates, Medicare typically does not cover routine vaccinations like the typhoid vaccine under Part B, which is where the MPFS would apply. However, coverage can vary based on specific circumstances, such as if the vaccine is deemed medically necessary due to a particular health condition or travel requirement.
Healthcare providers should verify with their local MAC for any region-specific coverage policies or exceptions that might apply to CPT code 90693. Additionally, it is advisable to check for any updates in the MPFS that might affect reimbursement status.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 90693. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer.
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