Wednesday, November 2, 2011

Vaccine CPT code updates on category I and III

AMA Releases Updates to Category I, III CPT Codes

 The American Medical Association has released updates to several Category I vaccine CPT codes.


The FDA pending indicator has been removed from CPT 90670, and CPT 90644 was approved after the AMA's October editorial meeting, according to the update.

The following Category I codes were revised in the update:
  • CPT 90663 (Influenza virus vaccine, pandemic formulation, H1N1)
  • CPT 90650 (Human Papilloma virus vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use)
  • CPT 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use)

The following Category I codes are new codes, according to the update:
  • CPT 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed)
  • CPT 90664 (Influenza virus vaccine, pandemic formulation, live, for intranasal use)
  • CPT 90666 (Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use)
  • CPT 90667 (Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use)
  • CPT 90668 (Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use)

 

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download