CPT code 90734 is a code used to identify the MenACWY vaccine, which protects against meningococcal disease.
CPT code 90734 is used to identify the administration of the meningococcal conjugate vaccine, specifically the MenACWY-D or MenACWY-CRM, given via intramuscular injection. This vaccine is designed to protect against meningococcal disease caused by serogroups A, C, W, and Y. It is commonly administered to adolescents and certain high-risk groups to prevent potentially severe infections such as meningitis and bloodstream infections. Proper coding of this vaccine is crucial for accurate billing and reimbursement in the healthcare revenue cycle.
For CPT code 90734, which pertains to the administration of the meningococcal vaccine, the following modifiers may be applicable depending on the specific circumstances of the service provided:
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.
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. This modifier is used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
6. Modifier SL: State Supplied Vaccine. This modifier is used when the vaccine is supplied by the state, indicating that the provider did not incur the cost of the vaccine.
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 the use of modifiers.
CPT code 90734 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) outlines the payment rates for services, including vaccinations, provided to Medicare beneficiaries. However, the actual reimbursement for CPT code 90734 can vary based on several factors, including geographic location and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that region.
Each MAC may have different local coverage determinations (LCDs) that can affect whether and how a particular service is reimbursed. Therefore, healthcare providers should verify the coverage details with their respective MAC to ensure compliance with Medicare's billing requirements and to understand any regional variations in reimbursement policies for CPT code 90734. Additionally, providers should ensure that the service is medically necessary and properly documented to facilitate reimbursement.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately identifying underpayments at the CPT code level, including specific codes like 90734, and by individual payer. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
