CPT code 90698 is a code used to identify the DTaP-IPV/Hib vaccine for immunization records and healthcare documentation.
CPT code 90698 is used to identify the administration of a combination vaccine that includes DTaP (Diphtheria, Tetanus, and acellular Pertussis), IPV (Inactivated Poliovirus), and Hib (Haemophilus influenzae type b). This vaccine is administered intramuscularly (IM) and is typically given to children to protect against these serious diseases. The use of this code in medical billing ensures that healthcare providers are accurately reimbursed for the administration of this multi-component vaccine.
For CPT code 90698, which pertains to the DTaP-IPV/Hib vaccine 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 significant, separately identifiable E/M service is performed in addition to 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 the same physician or other qualified health care professional. This modifier is used if the vaccine is administered more than once on the same day due to specific clinical circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used 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. While not typically used for vaccine administration, this modifier may be relevant if the vaccine administration is part of a telehealth visit where counseling or other services are provided.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is supplied by the state and not billed to the patient or insurance.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90698, which is associated with a specific vaccine, is generally reimbursed by Medicare under certain conditions. However, it's important to note that Medicare coverage for vaccines can vary based on the specific circumstances and the patient's eligibility. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services and their corresponding reimbursement rates, which can help determine if a particular service, such as the one associated with CPT code 90698, is covered.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in determining the coverage and reimbursement for specific CPT codes within their jurisdictions. They may have local coverage determinations (LCDs) that specify whether CPT code 90698 is reimbursed and under what conditions. Therefore, healthcare providers should consult the MPFS and their respective MACs to confirm the reimbursement status of CPT code 90698 for their specific region and patient circumstances.
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