How To Use CPT Code 90710

CPT 90710 refers to the administration of the measles, mumps, rubella, and varicella vaccine (MMRV) 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 90710 procedures.

1. What is CPT 90710?

CPT 90710 is a medical billing code used to describe the administration of the measles, mumps, rubella, and varicella vaccine (MMRV) for subcutaneous use. This vaccine is administered to prevent these diseases and is typically given to children between the ages of 12 months and 12 years.

2. 90710 CPT code description

The official description of CPT code 90710 is: “Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use.”

3. Procedure

The 90710 procedure involves the following steps:

1. The provider reviews the patient’s medical history and discusses the benefits, risks, and potential side effects of the MMRV vaccine with the parent, guardian, or patient.
2. The patient is appropriately prepped for the vaccine administration.
3. The provider administers the MMRV vaccine subcutaneously, typically in the arm or leg.
4. The provider monitors the patient for any immediate adverse reactions or side effects.
5. Appropriate documentation is completed, including the vaccine administration, product used, and administration route.

4. Qualifying circumstances

Patients eligible to receive CPT code 90710 services are typically children between the ages of 12 months and 12 years. The first dose of the MMRV vaccine should be administered soon after the child’s first birthday, at 12 to 15 months of age, and the second dose should be given before the start of kindergarten. In some cases, the vaccine may be administered to older children or adults who have not previously received the vaccine or who require additional doses for adequate immunity.

5. When to use CPT code 90710

It is appropriate to bill the 90710 CPT code when the provider administers the MMRV vaccine to a patient who meets the age and eligibility requirements. This code should be used for each administration of the vaccine, regardless of whether it is the first or second dose.

6. Documentation requirements

To support a claim for CPT 90710, the following information should be documented:

• Patient’s age and eligibility for the vaccine
• Date of vaccine administration
• Vaccine product used, including the National Drug Code (NDC) number
• Administration route (subcutaneous)
• Site of administration (e.g., arm or leg)
• Provider’s signature and credentials

7. Billing guidelines

When billing for CPT code 90710, it is important to follow payer-specific guidelines and requirements. Some insurance companies may require the use of modifier 25 when billing for an evaluation and management (E/M) service on the same day as the vaccine administration. Additionally, Medicare and private insurance companies may have different guidelines for reporting vaccines or for reporting certain vaccines during the same visit, such as flu and pneumonia vaccines. It is essential to check with individual payers for their specific guidelines and have the policy in writing to protect your practice in the event of payer questions or audits.

8. Historical information

CPT 90710 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition.

9. Similar codes to CPT 90710

Five similar codes to CPT 90710 and how they differ are:

• CPT 90707: This code is for the administration of the measles, mumps, and rubella (MMR) vaccine, without the varicella component.
• CPT 90716: This code is for the administration of the varicella vaccine alone, not in combination with the MMR vaccine.
• CPT 90715: This code is for the administration of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
• CPT 90670: This code is for the administration of the pneumococcal conjugate vaccine (PCV13).
• CPT 90686: This code is for the administration of the quadrivalent influenza vaccine.

10. Examples

Here are 10 detailed examples of CPT code 90710 procedures:

1. A 12-month-old child receives their first dose of the MMRV vaccine during a well-child visit.
2. A 4-year-old child receives their second dose of the MMRV vaccine before starting kindergarten.
3. An 8-year-old child who has not previously received the MMRV vaccine receives their first dose during a routine checkup.
4. A 10-year-old child with a history of incomplete immunizations receives their second dose of the MMRV vaccine.
5. A 15-year-old patient who has not previously received the MMRV vaccine receives their first dose during a physical exam.
6. An adult patient with no history of MMRV vaccination receives their first dose during a routine visit.
7. A 2-year-old child receives their first dose of the MMRV vaccine during a catch-up immunization visit.
8. A 5-year-old child receives their second dose of the MMRV vaccine during a routine checkup.
9. A 7-year-old child with a history of incomplete immunizations receives their first dose of the MMRV vaccine.
10. An adult patient with no history of MMRV vaccination receives their second dose during a follow-up visit.