CPT code 90716 is a code used to identify the administration of the varicella vaccine given subcutaneously.
CPT code 90716 is used to identify the administration of the varicella (chickenpox) vaccine, which is a live attenuated virus vaccine given subcutaneously. This code is utilized by healthcare providers to document and bill for the vaccination service provided to patients, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90716, which pertains to the Varicella (chickenpox) vaccine administered subcutaneously, 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 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 needs to be administered again on the same day due to specific circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the vaccine is administered again 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 commonly used with vaccine administration, this modifier could be applicable if the vaccine administration is part of a telehealth service.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is provided to the healthcare provider at no cost by the state.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90716, which is associated with a specific medical service, is reimbursed by Medicare under certain conditions. To determine if Medicare reimburses this code, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered by Medicare.
Additionally, reimbursement can vary based on the policies of the Medicare Administrative Contractor (MAC) that services the provider's geographic region. MACs are responsible for processing Medicare claims and can provide specific guidance on whether CPT code 90716 is covered and under what circumstances.
It is essential for healthcare providers to verify coverage and reimbursement details with their respective MAC to ensure compliance and accurate billing.
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