How To Use CPT Code 90680

CPT 90680 refers to the administration of a pentavalent rotavirus vaccine for infants, which helps prevent rotavirus-related gastroenteritis. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90680.

1. What is CPT 90680?

CPT 90680 is a medical billing code used to describe the administration of a pentavalent rotavirus vaccine for infants. This vaccine is given orally in a three-dose schedule to help prevent rotavirus-related gastroenteritis, which can cause severe vomiting and diarrhea, leading to dehydration in infants.

2. 90680 CPT code description

The official description of CPT code 90680 is: “Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use.”

3. Procedure

1. The healthcare provider discusses the benefits, risks, and potential side effects of the rotavirus vaccine with the parent, guardian, or patient.
2. The provider administers the first dose of the vaccine orally at two months of age.
3. The second dose is administered at four months of age.
4. The third and final dose is given at six months of age.
5. Providers may administer the rotavirus vaccine alongside other childhood vaccines.

4. Qualifying circumstances

Infants are eligible to receive CPT code 90680 services if they meet the following criteria:

• They are between six weeks and 14 weeks, six days of age when receiving the first dose.
• At least four weeks have elapsed between doses.
• All doses are completed by eight months of age.

5. When to use CPT code 90680

It is appropriate to bill the 90680 CPT code when a healthcare provider administers the pentavalent rotavirus vaccine to an infant following the recommended three-dose schedule. The vaccine should be given orally and in accordance with the qualifying circumstances mentioned above.

6. Documentation requirements

To support a claim for CPT 90680, the following information should be documented:

• The product administered, including the vaccine’s name and manufacturer.
• The administration route (oral).
• The purpose of the vaccine (prevention of rotavirus-related gastroenteritis).
• The date and age of the patient at the time of each dose.
• Any additional vaccines administered during the same visit.

7. Billing guidelines

When billing for CPT code 90680, keep in mind the following guidelines:

• Report separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation.
• Include sufficient documentation from your provider explaining the product administered, administration route, and purpose.
• Some insurance companies may require modifier 25 to be appended to the associated evaluation and management (E/M) code.
• Medicare and private insurance companies might have different guidelines for reporting vaccines or for reporting certain vaccines during the same visit. Check with individual payers for their specific guidelines and have the policy in writing to protect your practice.

8. Historical information

CPT 90680 was added to the Current Procedural Terminology system on January 1, 1999. The code has undergone the following changes:

• Code Changed on 01-01-2006: Rotavirus vaccine, tetravalent, live, for oral use.
• Code Changed on 01-01-2016: Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use.

9. Similar codes to CPT 90680

Five similar codes to CPT 90680 and how they differentiate are:

• CPT 90681: This code refers to the administration of a monovalent rotavirus vaccine, which protects against only one strain of rotavirus.
• CPT 90682: This code is for the administration of a bivalent rotavirus vaccine, which protects against two strains of rotavirus.
• CPT 90683: This code describes the administration of a trivalent rotavirus vaccine, which protects against three strains of rotavirus.
• CPT 90684: This code is for the administration of a quadrivalent rotavirus vaccine, which protects against four strains of rotavirus.
• CPT 90685: This code refers to the administration of a hexavalent rotavirus vaccine, which protects against six strains of rotavirus.

10. Examples

Here are 10 detailed examples of CPT code 90680 procedures:

1. A two-month-old infant receives the first dose of the pentavalent rotavirus vaccine during a well-child visit.
2. A four-month-old infant receives the second dose of the pentavalent rotavirus vaccine alongside other scheduled vaccinations.
3. A six-month-old infant receives the third and final dose of the pentavalent rotavirus vaccine during a routine checkup.
4. An infant receives the first dose of the pentavalent rotavirus vaccine at six weeks of age, the earliest recommended age for vaccination.
5. An infant receives the second dose of the pentavalent rotavirus vaccine at four months of age, with at least four weeks having elapsed since the first dose.
6. An infant receives the third dose of the pentavalent rotavirus vaccine at six months of age, completing the vaccination series before eight months of age.
7. A healthcare provider administers the pentavalent rotavirus vaccine to an infant during a visit for an unrelated minor illness, after discussing the benefits and risks with the parent or guardian.
8. An infant receives the pentavalent rotavirus vaccine alongside other childhood vaccines, such as the DTaP and Hib vaccines, during a well-child visit.
9. A healthcare provider documents the administration of the pentavalent rotavirus vaccine, including the product name, manufacturer, administration route, and purpose, to support a claim for CPT 90680.
10. A medical biller submits a claim for CPT 90680, including the appropriate documentation and any required modifiers, following the specific guidelines of the patient’s insurance company.