CPT code 90281 is a medical code used to identify human immunoglobulin for injection, facilitating accurate documentation and reimbursement processes.
CPT code 90281 is used to describe the administration of human immune globulin for intramuscular use. This code is typically utilized in situations where a patient requires passive immunity through the injection of antibodies, often to prevent or treat infections in individuals with compromised immune systems. The immune globulin is derived from pooled human plasma and is used to provide immediate, short-term protection against various infectious diseases. This code is important for healthcare providers to accurately document and bill for the administration of this specific type of immune therapy.
For CPT code 90281, which pertains to the administration of human immune globulin for intramuscular use, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. Documentation must support the substantial additional work and the reason for the additional work.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the procedure.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not typically applicable to administration codes, this modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer-specific policies. Proper documentation is essential to justify the use of any modifier.
CPT code 90281 is related to the administration of human immunoglobulin. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 90281 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this service. However, the actual reimbursement may vary based on local coverage determinations (LCDs) set by the MACs, which are responsible for processing Medicare claims and providing guidance on coverage policies in their respective jurisdictions.
To determine if CPT code 90281 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their MAC. This ensures compliance with Medicare's billing requirements and helps providers understand any specific documentation or medical necessity criteria that must be met for reimbursement.
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