How To Use CPT Code 90681

CPT 90681 describes the administration of two doses of live attenuated rotavirus vaccine by mouth to prevent rotavirus-related gastroenteritis with vomiting and diarrhea. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90681?

CPT 90681 can be used to describe the administration of two doses of live attenuated rotavirus vaccine by mouth. This vaccine is given to prevent rotavirus-related gastroenteritis, which is characterized by symptoms such as vomiting and diarrhea. The vaccine is typically administered to infants at two months and four months of age, with a minimum of four weeks between doses. It is important to complete all doses by eight months of age.

2. Official Description

The official description of CPT code 90681 is: ‘Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use.’

3. Procedure

1. The healthcare provider presents the parent, guardian, or patient with the options for immunization and explains the risks, benefits, and potential side effects of the rotavirus vaccine.
2. The provider administers the live attenuated rotavirus vaccine dose orally, or by mouth, to the patient.
3. For the two-dose vaccine schedule, the first dose is typically given at two months of age, and the second dose is given at four months of age. The vaccination may be given as early as six weeks of age or as late as 14 weeks and six days of age, but not later than that.
4. There must be a minimum of four weeks between doses, and all doses should be completed by eight months of age.
5. The provider may administer the rotavirus vaccine at the same time as other childhood vaccines.

4. Qualifying circumstances

CPT 90681 is used for the administration of the rotavirus vaccine to prevent rotavirus-related gastroenteritis. It is typically given to infants at two months and four months of age. The vaccine is administered orally, or by mouth, and must be completed by eight months of age. The vaccine is considered attenuated, meaning it is prepared from an altered form of a live virus that cannot cause disease but can protect against it.

5. When to use CPT code 90681

CPT code 90681 should be used when a healthcare provider administers two doses of live attenuated rotavirus vaccine by mouth to prevent rotavirus-related gastroenteritis. It is important to follow the recommended schedule and complete all doses by eight months of age. This code should not be used for other vaccines or for different dosing schedules.

6. Documentation requirements

To support a claim for CPT 90681, the healthcare provider must document the following information:

• The administration of two doses of live attenuated rotavirus vaccine
• The route of administration (oral)
• The dates of administration for each dose
• The age of the patient at the time of each dose
• Any relevant information about the patient’s medical history or contraindications
• Signature of the healthcare provider administering the vaccine

7. Billing guidelines

When billing for CPT 90681, ensure that the healthcare provider administers two doses of live attenuated rotavirus vaccine by mouth. Follow the recommended schedule and complete all doses by eight months of age. It is important to document the administration of the vaccine and any relevant information to support the claim. Check with individual payers for specific guidelines on reporting vaccines and associated evaluation and management codes.

8. Historical information

CPT 90681 was added to the Current Procedural Terminology system on January 1, 2009. There was a code change on January 1, 2016, which updated the description of the vaccine.

9. Examples

1. A healthcare provider administers the first dose of live attenuated rotavirus vaccine orally to an infant at two months of age. The second dose is administered at four months of age to complete the vaccine schedule.
2. An infant receives the first dose of live attenuated rotavirus vaccine orally at six weeks of age. The second dose is given at ten weeks of age to follow the recommended schedule.
3. A healthcare provider administers the first dose of live attenuated rotavirus vaccine orally to an infant at three months of age. The second dose is given at seven months of age to complete the vaccine schedule.
4. An infant receives the first dose of live attenuated rotavirus vaccine orally at two months of age. The second dose is administered at five months of age to follow the recommended schedule.
5. A healthcare provider administers the first dose of live attenuated rotavirus vaccine orally to an infant at four months of age. The second dose is given at six months of age to complete the vaccine schedule.
6. An infant receives the first dose of live attenuated rotavirus vaccine orally at two months of age. The second dose is administered at three months of age to follow the recommended schedule.
7. A healthcare provider administers the first dose of live attenuated rotavirus vaccine orally to an infant at six weeks of age. The second dose is given at twelve weeks of age to complete the vaccine schedule.
8. An infant receives the first dose of live attenuated rotavirus vaccine orally at three months of age. The second dose is administered at six months of age to follow the recommended schedule.
9. A healthcare provider administers the first dose of live attenuated rotavirus vaccine orally to an infant at two months of age. The second dose is given at four months of age to complete the vaccine schedule.