How To Use CPT Code 90734

CPT 90734 refers to the administration of a meningococcal conjugate vaccine for serogroups A, C, W, and Y. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90734 procedures.

1. What is CPT 90734?

CPT 90734 is a medical billing code used to describe the administration of a meningococcal conjugate vaccine, which protects patients from four strains of meningococcal viruses that cause diseases like meningitis and septicemia. This vaccine is administered intramuscularly and comes in two carrier forms: diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM).

2. 90734 CPT code description

The official description of CPT code 90734 is: “Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use.”

3. Procedure

  1. The provider presents the parent, guardian, or patient with the options for immunization with a meningococcal conjugate vaccine that provides immunity for the serogroups A, C, W, and Y.
  2. The provider reviews the risks and benefits along with the potential side effects of the vaccine.
  3. The patient is appropriately prepped for the vaccine administration.
  4. The provider administers one of the different brands of the vaccine (based upon availability, the age of the patient, and approved licensing), intramuscularly, usually in the deltoid muscle of the upper arm.

4. Qualifying circumstances

Patients eligible to receive CPT code 90734 services are those who require protection against meningococcal diseases caused by serogroups A, C, W, and Y. This includes infants less than one year of age, adolescents between 11 and 18 years old, and older patients between 16 and 21 years of age. Adolescents with HIV in these age groups may also receive the vaccine, following a different dosing schedule.

5. When to use CPT code 90734

It is appropriate to bill the 90734 CPT code when a provider administers a meningococcal conjugate vaccine to a patient who falls within the eligible age groups and requires protection against meningococcal diseases caused by serogroups A, C, W, and Y.

6. Documentation requirements

To support a claim for CPT 90734, the following information needs to be documented:

  • Patient’s age and medical history, including any pre-existing conditions or contraindications for the vaccine.
  • Details of the vaccine administered, including the brand, carrier type (MenACWY-D or MenACWY-CRM), and dosage.
  • Route of administration (intramuscular).
  • Location of the injection site (usually the deltoid muscle of the upper arm).
  • Provider’s discussion with the patient, parent, or guardian regarding the risks, benefits, and potential side effects of the vaccine.

7. Billing guidelines

When billing for CPT code 90734, it is important to follow the specific guidelines and rules set by Medicare and private insurance companies. These may include reporting separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation. Some insurance companies may require appending modifier 25 to the associated evaluation and management (E/M) code. Always check with individual payers for their specific guidelines and have their policy in writing to protect your practice in case of any discrepancies.

8. Historical information

CPT 90734 was added to the Current Procedural Terminology system on January 1, 2004. Since then, there have been several updates to the code description, with the most recent change occurring on July 1, 2019.

9. Similar codes to CPT 90734

Five similar codes to CPT 90734 and how they differentiate are:

  • CPT 90733: This code is for the administration of a meningococcal polysaccharide vaccine, which is a different type of meningococcal vaccine.
  • CPT 90644: This code refers to the administration of a meningococcal group C conjugate vaccine, which only covers serogroup C.
  • CPT 90620: This code is for the administration of a meningococcal group B vaccine, which covers a different serogroup than CPT 90734.
  • CPT 90621: This code refers to the administration of another type of meningococcal group B vaccine, also covering a different serogroup than CPT 90734.
  • CPT 90732: This code is for the administration of a pneumococcal polysaccharide vaccine, which protects against a different type of bacteria than meningococcal vaccines.

10. Examples

Here are 10 detailed examples of CPT code 90734 procedures:

  1. An 11-year-old patient receives their first dose of the meningococcal conjugate vaccine (MenACWY-D) in the deltoid muscle of the upper arm.
  2. A 16-year-old patient receives a booster dose of the meningococcal conjugate vaccine (MenACWY-CRM) in the deltoid muscle of the upper arm.
  3. An 18-year-old patient with HIV receives their third dose of the meningococcal conjugate vaccine (MenACWY-D) in the deltoid muscle of the upper arm.
  4. A 12-month-old infant receives their first dose of the meningococcal conjugate vaccine (MenACWY-CRM) in the deltoid muscle of the upper arm.
  5. A 21-year-old patient receives a meningococcal conjugate vaccine (MenACWY-D) in the deltoid muscle of the upper arm due to an increased risk of meningococcal disease.
  6. A 15-year-old patient receives their first dose of the meningococcal conjugate vaccine (MenACWY-CRM) in the deltoid muscle of the upper arm.
  7. An 11-year-old patient with a history of meningococcal disease receives a meningococcal conjugate vaccine (MenACWY-D) in the deltoid muscle of the upper arm.
  8. A 17-year-old patient receives a booster dose of the meningococcal conjugate vaccine (MenACWY-CRM) in the deltoid muscle of the upper arm before starting college.
  9. A 13-year-old patient receives their first dose of the meningococcal conjugate vaccine (MenACWY-D) in the deltoid muscle of the upper arm during a routine check-up.
  10. A 19-year-old patient receives a meningococcal conjugate vaccine (MenACWY-CRM) in the deltoid muscle of the upper arm before traveling to a high-risk area for meningococcal disease.

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