CPT code 90723 is a specific code used to identify the DTaP-Hep B-IPV vaccine administered via injection in healthcare settings.
CPT code 90723 is used to identify the administration of a combination vaccine that includes DTaP (Diphtheria, Tetanus, and acellular Pertussis), Hepatitis B, and IPV (Inactivated Poliovirus) given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the delivery of this multi-component vaccine, which is designed to protect against these specific infectious diseases in a single shot, thereby improving patient compliance and streamlining the vaccination process.
For CPT code 90723, which pertains to the administration of the DTaP-Hep B-IPV 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. Use this modifier if a significant, separately identifiable evaluation and management service is performed by the same provider 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. Use this modifier 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 91: Repeat Clinical Diagnostic Laboratory Test. Although not typically used for vaccine administration, this modifier may be applicable if the vaccine administration is part of a clinical diagnostic test that needs to be repeated.
6. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. This modifier is applicable if the vaccine administration service is provided via telemedicine, although this is rare for vaccine administration.
7. Modifier 99: Multiple Modifiers. Use this modifier when two or more modifiers are necessary to describe the service provided.
These modifiers should be used based on the specific circumstances of the service provided and in accordance with payer guidelines. Always ensure that documentation supports the use of any modifiers applied to the CPT code.
CPT code 90723 is associated with the DTaP-Hep B-IPV vaccine administered intramuscularly. Whether Medicare reimburses this specific CPT code depends on several factors, including the setting in which the service is provided and the patient's eligibility.
Medicare typically covers vaccines under Part B or Part D, depending on the type of vaccine and the circumstances of its administration. However, CPT code 90723 is generally not reimbursed by Medicare under the Medicare Physician Fee Schedule (MPFS) because it pertains to a pediatric vaccine, and Medicare primarily covers vaccines for adults, such as influenza, pneumococcal, and hepatitis B for high-risk individuals.
To determine if there are any exceptions or specific circumstances under which this code might be reimbursed, healthcare providers should consult their local Medicare Administrative Contractor (MAC). MACs are responsible for processing Medicare claims and can provide guidance on coverage policies and any potential exceptions. Additionally, providers should verify the latest updates in the MPFS and any relevant Medicare guidelines to ensure compliance and accurate billing practices.
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