CPT code 90701 is a code used to identify the administration of the DTP vaccine, which protects against diphtheria, tetanus, and pertussis.
CPT code 90701 is used to identify the administration of the DTP (Diphtheria, Tetanus, and Pertussis) vaccine via intramuscular injection. This code is utilized by healthcare providers to document and bill for the immunization service provided to patients, ensuring accurate reimbursement from insurance companies. The DTP vaccine is crucial for protecting individuals, particularly children, from these serious infectious diseases.
For CPT code 90701, which pertains to the administration of the DTP vaccine 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 if a significant, separately identifiable E/M service is provided in addition to the vaccine administration.
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 76: Repeat procedure or service by the 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 91: Repeat clinical diagnostic laboratory test. Although typically used for lab tests, this modifier can be relevant if the vaccine administration is part of a series of tests or procedures that need to be repeated for clinical reasons.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccines.
7. Modifier 99: Multiple modifiers. This modifier is used 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 with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 90701, which pertains to a specific medical service, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in interpreting and implementing Medicare policies, including coverage decisions for specific CPT codes like 90701. Providers should consult their local MAC for guidance on whether CPT code 90701 is reimbursed in their jurisdiction, as MACs may have specific regional policies or interpretations that affect reimbursement.
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 CPT code 90701, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
