CPT code 90721 is a code used to identify the DTaP/Hib vaccine for immunization purposes in healthcare documentation and reporting.
CPT code 90721 is used to identify the administration of a combination vaccine that includes both the DTaP (Diphtheria, Tetanus, and acellular Pertussis) and Hib (Haemophilus influenzae type b) vaccines. This code is specifically for the intramuscular (IM) injection of this combination vaccine. It is commonly used in pediatric care to protect children against these serious bacterial infections. Proper coding with 90721 ensures accurate billing and reimbursement for healthcare providers administering this essential immunization.
For CPT code 90721, which pertains to the administration of the DTaP/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 multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same 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 same 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 commonly used for vaccine administration, this modifier may be applicable if the service includes a telemedicine component.
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 to the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90721, which is associated with the administration of a DTaP/Hib vaccine, is generally not reimbursed by Medicare. Medicare typically does not cover routine immunizations for adults, as these are often covered under preventive services for children and adolescents. However, it's important to verify the specific coverage details through the Medicare Physician Fee Schedule (MPFS) and consult with your regional Medicare Administrative Contractor (MAC) for any exceptions or updates to coverage policies. The MACs are responsible for processing Medicare claims and can provide guidance on whether there are any circumstances under which this code might be reimbursed.
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