CPT code 90746 is a code used to identify the administration of the Hepatitis B vaccine in a three-dose series for adults.
CPT code 90746 is used to identify the administration of the hepatitis B vaccine for adults, specifically the three-dose schedule given via intramuscular injection. This code is utilized by healthcare providers to document and bill for the vaccination service provided to adult patients, ensuring proper reimbursement from insurance companies. The hepatitis B vaccine is crucial for preventing hepatitis B virus infection, which can lead to serious liver disease.
For CPT code 90746, which pertains to the administration of the Hepatitis B vaccine (3-dose schedule) for adults 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 is administered more than once on the same day by the same provider, which is uncommon but possible in specific clinical scenarios.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine is administered more than once on the same day by a different provider.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although not typically used for vaccines, this modifier might be relevant if the vaccine administration is part of a broader diagnostic process requiring repetition.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90746 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 the payment rates for services covered under Medicare Part B, including vaccines. However, the actual reimbursement may vary based on the locality and specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region. Each MAC may have different interpretations and implementations of Medicare policies, which can affect the reimbursement process. Therefore, it is crucial for healthcare providers to verify the coverage and reimbursement details with their respective MAC to ensure compliance and accurate billing.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 90746. Schedule a demo today to see how RevFind can help you ensure you're receiving the full reimbursement you're entitled to from each payer.
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