CPT code 90739 is a code used to identify the administration of the Hepatitis B vaccine for adults, specifically the second dose in a four-dose series.
CPT code 90739 is used to identify the administration of the hepatitis B vaccine for adults, specifically the 2-dose or 4-dose intramuscular (IM) regimen. This code is utilized by healthcare providers to document and bill for the vaccination process, ensuring that the correct immunization protocol is followed for adult patients. The hepatitis B vaccine is crucial for preventing hepatitis B virus infection, which can lead to serious liver disease. By using this code, providers can accurately track and manage the vaccination services they offer, facilitating proper reimbursement and maintaining compliance with healthcare regulations.
For CPT code 90739, which pertains to the administration of the Hepatitis B vaccine (2/4 dose, adult, intramuscular), 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 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 when the same procedure is repeated by the same provider, which could be relevant if multiple doses are administered on separate occasions.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated by a different provider, which might be relevant in a multi-provider practice setting.
5. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Although not typically associated with vaccine administration, if any part of the service involves telemedicine, this modifier may be applicable.
6. Modifier 99: Multiple Modifiers. This 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 they may have unique requirements for modifier usage.
CPT code 90739 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for this code. The MPFS outlines the payment policies and rates for services covered under Medicare Part B, including vaccinations.
However, the actual reimbursement for CPT code 90739 can vary based on geographic location and other factors, as determined by the Medicare Administrative Contractor (MAC) responsible for the region. MACs are private organizations contracted by Medicare to process claims and determine coverage specifics, including local coverage determinations (LCDs) that may affect reimbursement.
Healthcare providers should consult the MPFS and their respective MAC for the most accurate and up-to-date information regarding the reimbursement of CPT code 90739. This ensures compliance with Medicare's billing requirements and maximizes the likelihood of appropriate reimbursement.
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