How To Use CPT Code 90707

CPT 90707 refers to the administration of the measles, mumps, and rubella (MMR) vaccine for subcutaneous use. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90707 procedures.

1. What is CPT 90707?

CPT 90707 is a medical billing code used to describe the administration of the measles, mumps, and rubella (MMR) vaccine for subcutaneous use. This vaccine is a live combination vaccine that helps prevent these diseases by providing immunity to the patient. Medical professionals administer the MMR vaccine to eligible patients, typically children and certain adults, to protect them from these contagious and potentially severe illnesses.

2. 90707 CPT code description

The official description of CPT code 90707 is: “Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use.”

3. Procedure

The 90707 procedure involves the following steps:

1. The provider discusses the benefits, risks, and potential side effects of the MMR vaccine with the patient, parent, or guardian.
2. The patient is appropriately prepped for the vaccine administration.
3. The provider administers the MMR vaccine subcutaneously, typically in the arm or leg.
4. The provider documents the vaccine administration, including the product used, administration route, and purpose.

4. Qualifying circumstances

Eligible patients for CPT code 90707 services include:

• Children aged 12 to 15 months for their first dose of the MMR vaccine.
• Children before the start of kindergarten for their second dose of the MMR vaccine.
• Individuals born after 1956 who do not know their immunization status or have only received one MMR shot prior to entering school.
• Women of childbearing age who need to verify their immunity to rubella before becoming pregnant.

Providers should not administer the MMR vaccine to pregnant women or those planning to become pregnant within the next one to three months due to the potential for serious birth defects.

5. When to use CPT code 90707

It is appropriate to bill the 90707 CPT code when a qualified healthcare provider administers the MMR vaccine to an eligible patient following the recommended immunization schedule and guidelines. This code should be used for each administration of the MMR vaccine, regardless of whether it is the first or second dose.

6. Documentation requirements

To support a claim for CPT 90707, the following information should be documented:

• Patient’s age and immunization status.
• Discussion of the benefits, risks, and potential side effects of the MMR vaccine with the patient, parent, or guardian.
• Administration of the MMR vaccine, including the product used, administration route, and purpose.
• Any relevant medical history or contraindications for the MMR vaccine.

7. Billing guidelines

When billing for CPT code 90707, keep in mind the following guidelines and tips:

• Report separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation.
• Include sufficient documentation from the 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, such as flu and pneumonia vaccines. Check with individual payers for their specific guidelines and have the policy in writing to protect your practice.

8. Historical information

CPT 90707 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2004, with the previous descriptor being “Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous or jet injection use.”

9. Similar codes to CPT 90707

Five similar codes to CPT 90707 and how they differentiate are:

• CPT 90649: Human Papillomavirus (HPV) vaccine, administered intramuscularly.
• CPT 90670: Pneumococcal conjugate vaccine, administered intramuscularly.
• CPT 90680: Rotavirus vaccine, administered orally.
• CPT 90700: Diphtheria, Tetanus, and acellular Pertussis (DTaP) vaccine, administered intramuscularly.
• CPT 90715: Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, administered intramuscularly.

10. Examples

Here are 10 detailed examples of CPT code 90707 procedures:

1. A 12-month-old child receives their first dose of the MMR vaccine during a well-child visit.
2. A 4-year-old child receives their second dose of the MMR vaccine before starting kindergarten.
3. A 30-year-old individual with an unknown immunization status receives the MMR vaccine to ensure immunity.
4. A 25-year-old woman planning to become pregnant receives the MMR vaccine to verify her immunity to rubella.
5. A healthcare worker receives the MMR vaccine as part of their employment requirements.
6. An international traveler receives the MMR vaccine before traveling to a country with a high prevalence of measles, mumps, or rubella.
7. A college student receives the MMR vaccine as part of their school’s immunization requirements.
8. A patient with a compromised immune system receives the MMR vaccine under the guidance of their healthcare provider.
9. A patient receives the MMR vaccine during an outbreak of measles, mumps, or rubella in their community.
10. A patient receives the MMR vaccine as part of a catch-up immunization schedule after missing previous vaccinations.