CPT code 90736 is a code used to identify the live subcutaneous Hzv vaccine for healthcare providers in their documentation and reporting.
CPT code 90736 is used to identify the administration of the herpes zoster vaccine, commonly known as the shingles vaccine, which is a live, attenuated vaccine. This code is specifically used when the vaccine is administered subcutaneously, meaning it is injected into the layer of tissue just under the skin. This vaccine is typically recommended for older adults to help prevent shingles, a painful rash caused by the reactivation of the chickenpox virus. Proper use of this code ensures accurate billing and reimbursement for healthcare providers administering this vaccine.
The CPT code 90736, which pertains to the administration of the herpes zoster vaccine, live, subcutaneous, may require the use of certain modifiers to provide additional information about the service rendered. Here is a list of potential modifiers that could be used with this code:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed in addition to 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 the same physician or other qualified healthcare professional. This modifier is used 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 healthcare 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 used if the vaccine administration is part of a telemedicine service, although this is less common for vaccine administration.
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. It's important for healthcare providers to use the appropriate modifiers to avoid claim denials and ensure proper payment.
CPT code 90736, which is associated with the HZV vaccine live subcutaneous administration, is not reimbursed by Medicare under the Medicare Physician Fee Schedule (MPFS). This is because vaccines like the HZV vaccine are typically covered under Medicare Part D, which is the prescription drug benefit, rather than Part B, which covers physician services and other outpatient care.
Therefore, reimbursement for this vaccine would not be processed through the MPFS. Instead, coverage and reimbursement details would be managed by Medicare Part D plans, and healthcare providers should verify specific coverage with the patient's Medicare Part D plan or consult with their Medicare Administrative Contractor (MAC) for guidance on billing and reimbursement processes related to vaccines under Medicare.
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