CPT code 90713 is a code used to identify the poliovirus vaccine administered via subcutaneous or intramuscular injection.
CPT code 90713 is used to identify the administration of the inactivated poliovirus vaccine (IPV) given either subcutaneously (under the skin) or intramuscularly (into the muscle). This vaccine is designed to protect against poliomyelitis, a highly infectious viral disease that can lead to paralysis. The code is utilized by healthcare providers to document and bill for the vaccination service provided to patients, ensuring accurate reimbursement from insurance companies and other payers.
For CPT code 90713, which pertains to the administration of the 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 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 multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the same vaccine is administered more than once on the same day due to specific medical necessity.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This is used when the same 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 typically used for vaccine administration, it may be relevant if the service includes telehealth components for counseling or other related services.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the provider at no cost by the state.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. Always verify payer-specific guidelines, as modifier usage can vary between insurance companies.
CPT code 90713 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) outlines the payment rates for services covered under Medicare Part B, including vaccinations. However, the reimbursement for CPT code 90713 may vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Healthcare providers should consult the MPFS and their respective MAC to confirm the reimbursement details and ensure compliance with Medicare's billing requirements for this code.
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