CPT code 90748 is a specific code used to identify the Hib-HepB vaccine administered via injection in healthcare settings.
CPT code 90748 is used to identify the administration of a combination vaccine that protects against both Haemophilus influenzae type b (Hib) and Hepatitis B. This vaccine is given via intramuscular injection and is typically used in pediatric settings to immunize children against these two serious infections. The Hib component helps prevent infections like meningitis and pneumonia caused by the Haemophilus influenzae type b bacteria, while the Hepatitis B component protects against the Hepatitis B virus, which can lead to liver disease. This code is essential for healthcare providers to accurately document and bill for the administration of this specific combination vaccine.
For CPT code 90748, which pertains to the administration of the Hib-HepB vaccine intramuscularly, 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 administration is repeated on the same day by the same provider.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the vaccine administration is repeated 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 less common for vaccine administration, this modifier may be used if the service is provided via telemedicine under specific circumstances.
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's important to verify payer-specific guidelines, as modifier usage can vary between insurance companies.
The CPT code 90748, which is associated with the Hib-hepb vaccine administered intramuscularly, is indeed reimbursed by Medicare under specific circumstances. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services and procedures covered by Medicare. However, it's important to note that the reimbursement may vary based on the region and specific guidelines set forth by the Medicare Administrative Contractor (MAC) responsible for processing claims in that area. Each MAC has the authority to interpret national Medicare policies and apply them to local coverage decisions, which can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 90748.
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