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90702
Quick jump to procedure code: Printer Friendly Version
90710

CPT® 90707: MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FOR SUBCUTANEOUS USE

Short Description: Mmr vaccine sc

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
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CALIFORNIA NORTH-Santa Clara
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2016 OPPS Status Indicator: N

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
45.2% V06.4    Need for prophylactic vaccination, measles-mumps-rubella [MMR] Z23   Encounter for immunization
4.4% V03.82    Need for prophylactic vaccination, Streptococcus pneumoniae [pneumococcus] Z23   Encounter for immunization
3.7% 496    Chronic airway obstruction, not elsewhere classified J44.9   Chronic obstructive pulmonary disease, unspecified
3.0% V06.1    Need for prophylactic vaccination, Diphtheria-tetanus-pertussis, combined [DTP] [DtaP] Z23   Encounter for immunization
2.2% 493.20    Chronic obstructive asthma, unspecified J44.9   Chronic obstructive pulmonary disease, unspecified
2.2% 278.01    Morbid obesity E66.01   Morbid (severe) obesity due to excess calories
2.2% 272.4    Other and unspecified hyperlipidemia E78.4   Other hyperlipidemia
OR:
E78.5   Hyperlipidemia, unspecified
2.2% V04.81    Need for prophylactic vaccination and inoculation, Influenza Z23   Encounter for immunization
2.2% V70.3    Other medical examination for administrative purposes Z02.89   Encounter for other administrative examinations
2.2% V74.1    Special screening examination for pulmonary tuberculosis Z11.1   Encounter for screening for respiratory tuberculosis

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

90707 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 90707

CCI and MUE Edits*         Hide this section.

CCI Edits for 90707
Denied Codes (1) Effective Modifier
Accepted (2)
36591 Draw blood off venous device 10/01/2015 No
36592 Collect blood from picc 10/01/2015 No
90710 Mmrv vaccine sc 06/05/2000 No
(1) These codes will be denied when submitted for payment on the same date of service as 90707.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 90707

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 90707*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 9,214
Total Services Denied 2015: 9,214 (100.0%)
National Charges Submitted 2015: $ 819,180.00
National Charges Allowed 2015: $ 0.00
National Average (No Modifier) Fee Submitted 2015: $ 88.13
National Average (No Modifier) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Family practice 3,666 39.8% $ 90.18 3,666 100.0%
Internal medicine 2,708 29.4% $ 94.07 2,708 100.0%
Nurse practitioner 1,334 14.5% $ 78.35 1,334 100.0%
Physician assistant
(eff 5/92)
242 2.6% $ 93.58 242 100.0%
Pediatric medicine 227 2.5% $ 65.66 227 100.0%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 8,677 94.2% $ 89.72 8,677 100.0%
State or local public health clinic 359 3.9% $ 70.25 359 100.0%
Outpatient hospital 57 0.6% $ 95.16 57 100.0%
Urgent Care Facility (eff. 1/1/03) 49 0.5% $ 91.92 49 100.0%
Mass immunizations center (eff. 9/1/97) 12 0.1% $ 75.69 12 100.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 8,160 88.6% $ 88.14 8,160 100.0%
GY 569 6.2% $100.36 569 100.0%
GA - Advanced Beneficiary Notice (ABN) on File 376 4.1% $ 86.35 376 100.0%
GZ - Service Expected to be Denied as Not Reasonable and Necessary 31 0.3% $106.76 31 100.0%
59 - Distinct Procedural Service 25 0.3% $103.65 25 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

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09/28/2016 10:20:27 54.242.9.97

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