CPT code 90283 is a code used to identify the administration of human immunoglobulin intravenous therapy for patients.
CPT code 90283 is used to describe the administration of human immune globulin intravenously (IV). This code is specifically utilized when billing for the infusion of immune globulin, which is a blood product containing antibodies that help fight infections. The intravenous administration of immune globulin is often used in patients with immune deficiencies, autoimmune diseases, or certain infections to boost their immune system. This code is crucial for healthcare providers to ensure accurate billing and reimbursement for the specialized treatment provided.
For CPT code 90283, which pertains to the administration of human immunoglobulin intravenously, the following modifiers may be applicable depending on the specific circumstances of the service provided:
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 it.
2. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: Use this modifier 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 qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although not typically used with drug administration codes, if the context involves repeated laboratory testing related to the administration, this modifier might be applicable.
These modifiers should be used in accordance with payer policies and specific clinical scenarios to ensure accurate billing and reimbursement. Proper documentation is essential to support the use of any modifier.
CPT code 90283 is associated with the administration of human immunoglobulin intravenously. 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 90283 is listed on the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to any applicable coverage policies.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and making coverage decisions based on local policies. Each MAC may have specific criteria or documentation requirements that must be met for CPT code 90283 to be reimbursed.
Healthcare providers should verify the inclusion of CPT code 90283 in the MPFS and consult with their regional MAC to ensure compliance with any local coverage determinations or additional requirements that may affect reimbursement.
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