CPT CODES

CPT Code 90718

CPT code 90718 is a code used to identify the Td vaccine for individuals over 7 years old in healthcare documentation and reporting.

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What is CPT Code 90718

CPT code 90718 is used to describe the administration of the tetanus and diphtheria toxoids vaccine for individuals over the age of seven. This vaccine is given via intramuscular injection and is commonly referred to as the Td vaccine. It is typically administered as a booster shot to maintain immunity against tetanus and diphtheria, which are serious bacterial infections. This code is used by healthcare providers to document and bill for the vaccination service provided to patients.

Does CPT 90718 Need a Modifier?

For CPT code 90718, which pertains to the Td vaccine administered intramuscularly to individuals over 7 years of age, 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 patient receives a vaccine and also has a separate evaluation and management service on the same day.

2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the vaccine administration is distinct or independent from other services provided on the same day.

3. Modifier 76: Repeat procedure or service by the 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 91: Repeat clinical diagnostic laboratory test. Although not typically used for vaccines, this modifier might be relevant if the vaccine administration is part of a broader diagnostic process requiring repetition.

6. 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 direct administration would not typically apply.

These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. Always verify with the latest coding guidelines and payer-specific requirements to ensure correct usage.

CPT Code 90718 Medicare Reimbursement

CPT code 90718, which is associated with the Td vaccine for individuals over 7 years of age administered intramuscularly, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually.

Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region. MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies, including any local coverage determinations (LCDs) that may affect the reimbursement of CPT code 90718. Since Medicare coverage can vary based on geographic location and specific circumstances, verifying with the MAC ensures that providers have the most accurate and up-to-date information regarding reimbursement for this code.

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