CPT code 90732 is a code used to identify the PPSV23 vaccine administered to patients aged 2 years and older via subcutaneous or intramuscular injection.
CPT code 90732 is used to identify the administration of the pneumococcal polysaccharide vaccine (PPSV23) for individuals aged 2 years and older. This vaccine is administered either subcutaneously (under the skin) or intramuscularly (into the muscle) and is designed to protect against pneumococcal diseases, which can lead to serious infections like pneumonia, meningitis, and bloodstream infections. The code is utilized by healthcare providers to ensure accurate billing and documentation of the vaccine administration in the patient's medical records.
For CPT code 90732, which pertains to the administration of the pneumococcal polysaccharide vaccine (PPSV23) for patients aged 2 years and older via subcutaneous or intramuscular injection, 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 (E/M) 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 is administered more than once on the same day by the same provider, which is uncommon but possible in specific clinical scenarios.
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 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Although not typically applicable to vaccine administration, if the consultation or evaluation related to the vaccine is conducted via telemedicine, this modifier may be used.
6. Modifier 99: Multiple Modifiers. This modifier is used when two or more modifiers are necessary to describe the service provided.
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 modifier requirements can vary.
CPT code 90732, which is associated with the administration of a specific vaccine, is reimbursed by Medicare under certain conditions. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the coverage and reimbursement specifics can vary based on the guidelines set by the local Medicare Administrative Contractor (MAC). Each MAC may have different policies regarding the administration and billing of vaccines, so it is crucial for healthcare providers to verify the local MAC's guidelines to ensure compliance and proper reimbursement for CPT code 90732.
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