CPT code 90712 is a code used to identify the oral poliovirus vaccine for healthcare providers in their documentation and reporting processes.
CPT code 90712 is used to identify the administration of the oral poliovirus vaccine. This code is specifically designated for the oral form of the vaccine, which is used to immunize individuals against poliomyelitis, a viral disease that can cause paralysis and other serious health issues. The oral poliovirus vaccine is typically administered in a liquid form and is part of routine immunization schedules to prevent the spread of polio. This CPT code is essential for healthcare providers to accurately document and bill for the vaccine administration in their practice management systems.
For CPT code 90712, which pertains to the oral poliovirus vaccine, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional 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 conjunction with the administration of the vaccine.
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 a different session or encounter.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare 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 healthcare 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. Although not commonly used with vaccines, this modifier may be applicable if the vaccine administration is part of a telehealth service where the provider is guiding the administration remotely.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided, and the payer requires the use of this modifier to indicate multiple modifiers.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for the use of modifiers.
CPT code 90712, which pertains to the oral poliovirus vaccine, is not reimbursed by Medicare. The Medicare Physician Fee Schedule (MPFS) does not include 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) follow the guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) and do not provide reimbursement for this particular vaccine under Medicare Part B. Healthcare providers should verify coverage details with their specific MAC to ensure compliance and accurate billing practices.
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 specific codes like 90712, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
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