CPT code 90700 is a code used to identify the DTaP vaccine for children under 7 years old in healthcare documentation and reporting.
CPT code 90700 is used to identify the administration of the DTaP vaccine, which is designed for children under the age of 7. This vaccine provides immunization against three serious diseases: diphtheria, tetanus, and acellular pertussis (whooping cough). The "im" in the description indicates that the vaccine is administered intramuscularly. This code is essential for healthcare providers to accurately document and bill for the vaccine's administration, ensuring proper reimbursement and maintaining precise medical records.
For CPT code 90700, which pertains to the DTaP vaccine for children under 7 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 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 the vaccine is administered in conjunction with other services that are not typically reported together.
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 by the same provider.
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 commonly used with vaccine administration, this modifier could be applicable if the service involves telehealth components.
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 is essential to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90700 is reimbursed by Medicare under specific circumstances. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services covered by Medicare, including vaccines. However, it's important to note that Medicare typically covers vaccines under Part D or Part B, depending on the context and the patient's eligibility.
For CPT code 90700, which pertains to the DTaP vaccine for children under 7 years, Medicare coverage is generally not applicable since Medicare primarily covers individuals aged 65 and older, or those with specific disabilities. However, in certain situations, such as when the vaccine is administered as part of a broader public health initiative or under specific Medicare Advantage plans, there might be exceptions.
To determine if CPT code 90700 is reimbursed in a particular scenario, healthcare providers should consult their regional Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide guidance on coverage specifics, including any local coverage determinations (LCDs) that might affect reimbursement for this code.
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