CPT code 90696 is a code used to identify the DTaP-IPV vaccine for children aged 4-6 years administered via injection.
CPT code 90696 is used to identify the administration of the DTaP-IPV vaccine, which is a combination vaccine that protects against four diseases: diphtheria, tetanus, pertussis (whooping cough), and polio. This specific code is applicable when the vaccine is administered to children aged 4 to 6 years via an intramuscular injection. This code is crucial for healthcare providers to ensure accurate billing and reimbursement for the vaccine administration as part of pediatric immunization schedules.
For CPT code 90696, which pertains to the DTaP-IPV vaccine for children aged 4-6 years administered intramuscularly, 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 vaccine is administered during a visit that also includes a significant, separately identifiable E/M service.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the vaccine administration is distinct or independent from other services performed on the same day.
3. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the healthcare provider at no cost by the state.
4. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier may be used if the vaccine needs to be administered again due to specific circumstances.
5. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is applicable if the vaccine is administered again by a different provider.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. Although not commonly used for vaccine administration, this modifier might be relevant if the vaccine administration is part of a telehealth service where applicable.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90696, which is associated with the Dtap-ipv vaccine for children aged 4-6 years administered intramuscularly, is generally not reimbursed by Medicare. Medicare typically does not cover routine vaccinations for children, as it primarily serves individuals aged 65 and older, as well as certain younger individuals with disabilities or specific conditions.
For healthcare providers seeking reimbursement for this code, it is important to consult the Medicare Physician Fee Schedule (MPFS) to confirm coverage details and reimbursement rates for services that are applicable to the Medicare population. Additionally, providers should check with their specific Medicare Administrative Contractor (MAC) for any local coverage determinations or specific billing guidelines that might affect reimbursement for this code.
In summary, while CPT code 90696 is not typically reimbursed by Medicare, healthcare providers should verify with the MPFS and their MAC for any updates or exceptions that might apply.
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