CPT code 90738 is a code used to identify the inactivated Japanese encephalitis vaccine for immunization purposes.
CPT code 90738 is used to describe the administration of the Japanese encephalitis vaccine, which is inactivated. This code is specifically utilized by healthcare providers to document and bill for the service of administering this particular vaccine to patients. The Japanese encephalitis vaccine is important for individuals traveling to or living in areas where the disease is prevalent, as it helps protect against the virus transmitted through mosquito bites. By using CPT code 90738, healthcare providers ensure accurate billing and reimbursement for the vaccination service provided.
For CPT code 90738, which pertains to the administration of the inactivated Japanese encephalitis vaccine, the following modifiers may be applicable:
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 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 the same physician or other qualified healthcare 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 healthcare 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 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's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90738 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, including their respective reimbursement rates. However, it is important to note that the reimbursement for CPT code 90738 may vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Healthcare providers should consult their local MAC for detailed information on coverage and reimbursement specifics for CPT code 90738.
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