CPT code 90743 is a code used to identify the administration of the Hepatitis B vaccine for adolescents in two doses.
CPT code 90743 is used to identify the administration of the hepatitis B vaccine, specifically the two-dose regimen intended for adolescents. This code is utilized by healthcare providers to document and bill for the intramuscular injection of this vaccine, which is designed to protect against the hepatitis B virus. The two-dose schedule is typically recommended for adolescents aged 11 to 15 years, offering a convenient and effective way to ensure immunity against this potentially serious liver infection.
For CPT code 90743, which pertains to the administration of the Hepatitis B vaccine (2-dose schedule) for adolescents via intramuscular injection, 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 multiple vaccines are administered and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine administration is repeated by the same provider on the same day.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine administration is repeated by a different provider on the same day.
5. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. While not typically applicable to vaccine administration, if any part of the service involves telemedicine, this modifier may be used.
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 for the services rendered. It is important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90743 is associated with the administration of a hepatitis B vaccine, specifically a 2-dose regimen for adolescents. Whether this code is reimbursed by Medicare depends on several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) for your region.
Under the MPFS, Medicare typically covers vaccines that are deemed necessary for preventive care, but coverage can vary based on the specific circumstances and the patient's eligibility. It's important to consult the MPFS to determine if CPT code 90743 is listed and what the reimbursement rate might be.
Additionally, each MAC may have specific guidelines and policies regarding the reimbursement of vaccines, including CPT code 90743. MACs are responsible for processing Medicare claims and can provide detailed information on whether this particular code is covered in your area.
To ensure accurate reimbursement, healthcare providers should verify the coverage details with their local MAC and review the latest updates to the MPFS. This will help in understanding any regional variations in coverage and ensure compliance with Medicare billing requirements.
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