CPT code 90709 is a specific code used to identify the rubella and mumps vaccine administered via subcutaneous injection.
CPT code 90709 is used to identify the administration of a combined rubella and mumps vaccine given subcutaneously. This code is utilized by healthcare providers to document and bill for the delivery of this specific immunization, which is designed to protect against both rubella (German measles) and mumps. The use of this code ensures accurate tracking and reimbursement for the vaccine administration within the healthcare revenue cycle.
For CPT code 90709, which pertains to the administration of the rubella and mumps 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 necessary 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 99: Multiple Modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
These modifiers are used to provide additional information about the service performed and ensure accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90709, which pertains to a specific vaccine, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not list this code for reimbursement, as Medicare typically does not cover vaccines that are not directly related to influenza, pneumococcal infections, or hepatitis B for high-risk individuals.
Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing claims and determining coverage specifics, generally follow the guidelines set forth by the MPFS. Therefore, healthcare providers should verify coverage details with their respective MACs to confirm the non-reimbursable status of CPT code 90709 under Medicare.
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