CPT code 90735 is a unique identifier for the encephalitis vaccine administered subcutaneously, used for tracking and documentation in healthcare.
CPT code 90735 is used to identify the administration of an encephalitis vaccine via subcutaneous injection. This code is specifically utilized by healthcare providers to document and bill for the service of delivering this particular vaccine, which is designed to protect against encephalitis, a serious condition characterized by inflammation of the brain. The use of this code ensures accurate tracking and reimbursement for the vaccination service provided.
For CPT code 90735, which pertains to the administration of the encephalitis vaccine subcutaneously, 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 necessary 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 needs to be 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. This modifier is applicable if the vaccine administration counseling or related services are provided via telemedicine.
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 about the circumstances under which the vaccine was administered. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90735, which is associated with the encephalitis vaccine, is not typically reimbursed by Medicare. Medicare coverage for vaccines is generally limited to those that are directly related to the prevention of illnesses that pose a significant risk to the Medicare population, such as influenza, pneumococcal, and hepatitis B vaccines.
To determine if there are any exceptions or specific circumstances under which CPT code 90735 might be reimbursed, healthcare providers should consult the Medicare Physician Fee Schedule (MPFS) and reach out to their respective Medicare Administrative Contractor (MAC). The MAC is responsible for processing Medicare claims and can provide guidance on coverage policies, including any local coverage determinations (LCDs) that might affect reimbursement for this specific code.
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