CPT code 90715 is a code used to identify the Tdap vaccine for individuals aged 7 years and older administered via intramuscular injection.
CPT code 90715 is used to identify the administration of the Tdap vaccine, which is designed for individuals aged 7 years and older. The Tdap vaccine provides immunization against tetanus, diphtheria, and pertussis (whooping cough) and is administered via intramuscular injection. This code is utilized by healthcare providers to accurately document and bill for the vaccine's administration in medical records and insurance claims, ensuring proper reimbursement and tracking of immunization services.
For CPT code 90715, which pertains to the Tdap vaccine for individuals aged 7 years and older administered intramuscularly, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) 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 the vaccine is administered in conjunction with other procedures that are not typically performed together.
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. While not typically applicable to vaccine administration, if any part of the service involves telemedicine, this modifier may be relevant.
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 for the services rendered. It is important to review payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90715, which is associated with the Tdap vaccine for individuals aged 7 years and older, is reimbursed by Medicare under specific circumstances. Medicare coverage for vaccines, including the Tdap vaccine, is typically provided under Medicare Part D, but certain vaccines may also be covered under Medicare Part B if they are directly related to the treatment of an injury or direct exposure to a disease or condition.
To determine if CPT code 90715 is reimbursed under Medicare Part B, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) and the guidelines provided by their respective Medicare Administrative Contractor (MAC). The MPFS outlines the payment rates for services covered under Medicare Part B, while the MACs are responsible for processing Medicare claims and providing guidance on coverage and reimbursement policies.
It is important for healthcare providers to verify the specific coverage criteria and reimbursement rates for CPT code 90715 with their MAC, as these can vary based on geographic location and other factors. Additionally, providers should ensure that they meet all necessary documentation and billing requirements to facilitate proper reimbursement.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 90715, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and optimize your revenue cycle management.
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
