CPT code 90750 is a code used to identify the recombinant human papillomavirus vaccine administered via injection.
CPT code 90750 is used to describe the administration of the herpes zoster vaccine, specifically the recombinant version, which is given via intramuscular injection. This vaccine is designed to prevent shingles, a painful rash caused by the reactivation of the chickenpox virus in adults. The recombinant vaccine is a newer formulation that does not use a live virus, making it suitable for a broader range of patients, including those with weakened immune systems. This code is essential for healthcare providers to accurately bill for the vaccine's administration and ensure proper reimbursement from insurance companies.
For CPT code 90750, which pertains to the administration of the herpes zoster vaccine (recombinant, subunit, adjuvanted), the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed in addition to 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 the same physician or other qualified health care professional. This modifier is used if the same vaccine is administered more than once on the same day due to special circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the same 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. While not typically used for vaccine administration, it may be applicable if the vaccine counseling or related services are provided via telemedicine.
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 about the services rendered. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 90750, which pertains to a specific service, is indeed reimbursed by Medicare, but there are specific considerations to keep in mind.
The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC).
Each MAC has the authority to interpret national Medicare policies and apply them to their specific jurisdiction, which can affect whether and how a particular CPT code like 90750 is reimbursed.
Therefore, healthcare providers should verify the reimbursement specifics with their local MAC to ensure compliance and accurate billing.
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