CPT code 90747 is a code used to identify the administration of a four-dose hepatitis B vaccine for immunosuppressed individuals.
CPT code 90747 is used to describe the administration of the hepatitis B vaccine in a four-dose schedule specifically for patients who are immunosuppressed. This code is applicable when the vaccine is given intramuscularly to individuals whose immune systems are compromised, requiring an adjusted vaccination schedule to ensure adequate protection against hepatitis B. This code is crucial for healthcare providers to accurately document and bill for the specialized vaccination process tailored to the needs of immunosuppressed patients.
For CPT code 90747, which is used for the administration of the Hepatitis B vaccine in a 4-dose schedule for immunosuppressed patients, 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 if the vaccine is administered more than once on the same day by the same provider, which is uncommon but possible in certain 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 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Although not typically applicable to vaccine administration, this modifier could be relevant if the vaccine administration is part of a telemedicine service where the provider is guiding the administration remotely.
6. Modifier 99: Multiple Modifiers. This is used when two or more modifiers are necessary to describe the service provided.
It is important to verify payer-specific guidelines as they may have unique requirements for the use of modifiers with vaccine administration codes.
CPT code 90747 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, the final decision on whether CPT code 90747 is reimbursed can vary based on local coverage determinations (LCDs) made by the MAC.
These contractors have the authority to establish specific guidelines and criteria for reimbursement, which can include medical necessity and documentation requirements. Therefore, it is crucial for healthcare providers to consult the MPFS and their regional MAC to confirm the reimbursement status of CPT code 90747.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 90747. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer.
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