CPT code 90719 is a code used to identify the diphtheria vaccine for immunization purposes in healthcare settings.
CPT code 90719 is used to identify the administration of a diphtheria vaccine via intramuscular injection. This code is utilized by healthcare providers to document and bill for the service of administering the diphtheria vaccine, which is crucial for preventing diphtheria, a serious bacterial infection. Proper use of this code ensures accurate billing and reimbursement for the vaccination service provided.
For CPT code 90719, which pertains to the administration of the diphtheria vaccine via intramuscular injection, 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 the vaccine administration is performed in conjunction with other procedures that are not typically reported 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 the service includes a telehealth component, this modifier might be relevant.
6. Modifier SL: State-supplied vaccine. This modifier is used when the vaccine is supplied by the state and not billed to the patient or insurance.
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.
CPT code 90719 is associated with the administration of the diphtheria vaccine intramuscularly. Whether this specific CPT code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the regional Medicare Administrative Contractor (MAC).
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. If CPT code 90719 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this service. However, the actual reimbursement can vary based on geographic location and other factors determined by the MAC.
Each MAC has the authority to interpret national Medicare policies and may have specific local coverage determinations (LCDs) that affect whether a particular service is reimbursed. Therefore, to determine if CPT code 90719 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their regional MAC.
In summary, while CPT code 90719 may be listed on the MPFS, its reimbursement by Medicare is ultimately subject to the guidelines and determinations of the applicable MAC. Healthcare providers should verify the latest information with their MAC to ensure compliance and accurate billing.
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