CPT code 90694 is a code used to identify the administration of a specific flu vaccine without preservatives, given via injection.
CPT code 90694 is used to identify the administration of a quadrivalent influenza vaccine, which is designed to protect against four different flu viruses. This specific vaccine is preservative-free and is administered intramuscularly in a 0.5 milliliter dosage. The quadrivalent nature of the vaccine means it covers two influenza A viruses and two influenza B viruses, offering broader protection against the flu. This code is typically used by healthcare providers to ensure accurate billing and documentation when this particular vaccine is given to patients.
For CPT code 90694, which pertains to the administration of a 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 significant, separately identifiable evaluation and management 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 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 may be used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied by the state, indicating that the provider did not incur the cost of the vaccine.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 90694 is associated with a specific service that may be reimbursed by Medicare, depending on several factors. To determine if Medicare reimburses this code, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. The MPFS provides detailed information on whether a particular CPT code is reimbursable and the associated payment amount.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide guidance on coverage and reimbursement policies specific to their jurisdiction. Providers should verify with their local MAC to confirm if CPT code 90694 is covered and to understand any specific billing requirements or documentation needed for reimbursement.
In summary, while CPT code 90694 may be reimbursed by Medicare, it is essential for healthcare providers to review the MPFS and consult with their MAC to ensure compliance with Medicare's reimbursement policies.
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