CPT code 90705 is a specific code used to identify the measles vaccine administered via subcutaneous injection.
CPT code 90705 is used to identify the administration of the measles vaccine via subcutaneous injection. This code is utilized by healthcare providers to document and bill for the delivery of the measles vaccine, which is crucial for preventing the spread of measles, a highly contagious viral infection. The use of this specific CPT code ensures accurate tracking and reimbursement for the vaccination service provided.
For CPT code 90705, which pertains to the administration of the measles vaccine subcutaneously, 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 the vaccine administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by 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. This modifier is 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 a cost for the vaccine itself.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important for healthcare providers to use the appropriate modifiers to avoid claim denials and ensure compliance with payer requirements.
CPT code 90705 is associated with the administration of the measles vaccine. When it comes to reimbursement by Medicare, it's important to note that Medicare typically does not cover routine vaccinations for adults, including the measles vaccine, unless they are part of a specific preventive service covered under Medicare Part B. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of services and their corresponding reimbursement rates, but routine adult vaccinations like the measles vaccine are generally not included unless they are part of a broader preventive service.
Furthermore, Medicare Administrative Contractors (MACs) are responsible for processing claims and can provide specific guidance on coverage and reimbursement policies in their respective jurisdictions. Providers should consult their local MAC for detailed information on whether there are any exceptions or specific circumstances under which CPT code 90705 might be reimbursed. However, as a general rule, this code is not reimbursed by Medicare for routine adult vaccination purposes.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 90705. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
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