CPT code 90636 is a code used to identify the Hepatitis A and B vaccine administered to adults via injection.
CPT code 90636 is used to identify the administration of a combination vaccine for Hepatitis A and Hepatitis B, specifically for adult patients. This code is utilized in medical billing to document and charge for the intramuscular (IM) injection of this dual vaccine, which is designed to protect against both Hepatitis A and Hepatitis B infections. By using this code, healthcare providers can ensure accurate billing and reimbursement for the vaccine administration as part of their revenue cycle management processes.
For CPT code 90636, which pertains to the administration of the Hepatitis A and Hepatitis B vaccine 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 or other qualified healthcare 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 the vaccine administration is distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the vaccine needs to be administered again on the same day due to specific circumstances.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used if the vaccine is administered again 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 applicable if the vaccine administration is part of a series of tests or procedures that need to be repeated.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the vaccine administration is part of a telemedicine service, although direct administration would still require in-person interaction.
7. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service accurately.
These modifiers help ensure accurate billing and documentation of the vaccine administration, reflecting any additional services or circumstances surrounding the procedure. Always verify with the latest coding guidelines and payer-specific requirements, as these can influence the use of modifiers.
CPT code 90636 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) provides the framework for determining the reimbursement rates for services covered under Medicare Part B, including vaccinations. However, the actual reimbursement for CPT code 90636 can vary based on the region and the specific Medicare Administrative Contractor (MAC) responsible for processing claims in that area. Each MAC may have different local coverage determinations (LCDs) that can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to ensure compliance and accurate reimbursement for CPT code 90636.
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