CPT code 90720 is a code used to identify the administration of the DTP/Hib vaccine for immunization purposes in healthcare settings.
CPT code 90720 is used to identify the administration of a combination vaccine that includes Diphtheria, Tetanus toxoids, and Pertussis (DTP) along with Haemophilus influenzae type b (Hib) vaccine, delivered via intramuscular injection. This code is utilized by healthcare providers to document and bill for the immunization service provided to patients, ensuring accurate reimbursement and record-keeping within the healthcare revenue cycle.
For CPT code 90720, which pertains to the administration of the DTP/Hib vaccine intramuscularly, 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 significant, separately identifiable evaluation and management service is performed by the same physician on the same day as 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 Same Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine administration is repeated 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 administration is repeated 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. Although not commonly used for vaccine administration, this modifier may be applicable if the service is part of a telemedicine encounter.
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 about the services rendered. It is important to verify payer-specific guidelines, as the applicability of modifiers can vary.
CPT code 90720, which is associated with the administration of a DTP/Hib vaccine, is not reimbursed by Medicare. Medicare typically does not cover vaccines that are primarily administered to children, as these are generally covered under Medicaid or private insurance plans. The Medicare Physician Fee Schedule (MPFS) does not list CPT code 90720 for reimbursement because it falls outside the scope of services typically covered for the Medicare population, which primarily consists of individuals aged 65 and older.
Additionally, Medicare Administrative Contractors (MACs), which are responsible for processing Medicare claims and determining local coverage decisions, do not include CPT code 90720 in their list of reimbursable services. Healthcare providers should verify coverage specifics with their respective MACs and consider alternative billing options for vaccines not covered by Medicare.
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