CPT code 90284 is a code used to identify the administration of human immunoglobulin subcutaneously, ensuring accurate documentation and reimbursement.
CPT code 90284 is used to describe the administration of human immune globulin subcutaneously (SC). This code is specifically for the injection of immune globulin, which is a blood product used to boost the immune system in patients who may have immune deficiencies or require additional immune support. The subcutaneous route refers to the method of administering the medication under the skin, which is often preferred for its convenience and reduced risk of systemic side effects compared to intravenous administration. This code is crucial for healthcare providers to accurately document and bill for the service provided, ensuring proper reimbursement and maintaining compliance with healthcare regulations.
For CPT code 90284, which pertains to Human Immunoglobulin Subcutaneous (Ig SC), 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. It may be applicable if the administration of the immunoglobulin required significantly more effort or time due to patient-specific factors.
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 provider on the same day as the procedure. It may be relevant if an E/M service was necessary in addition to the administration of the immunoglobulin.
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 may be used if the administration of the immunoglobulin was performed in a different session or for a different condition than other services provided on the same day.
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 provider. It may be applicable if the immunoglobulin administration needed to be repeated on the same day.
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 a different provider. It may be relevant if the immunoglobulin administration was repeated by another healthcare professional on the same day.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can sometimes be relevant if the administration of the immunoglobulin is part of a repeated diagnostic process.
7. Modifier 99 - Multiple Modifiers: This modifier is used when two or more modifiers are necessary to describe the service provided. It may be applicable if multiple modifiers are needed to accurately represent the circumstances of the immunoglobulin administration.
These modifiers should be used judiciously and only when the specific circumstances of the service meet the criteria for their application. Proper documentation is essential to support the use of any modifier.
CPT code 90284 is associated with the administration of human immunoglobulin subcutaneously. To determine if this code is reimbursed by Medicare, one must consult the Medicare Physician Fee Schedule (MPFS) and the guidelines set forth by the relevant Medicare Administrative Contractor (MAC) for the specific region.
The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates. However, coverage and reimbursement can vary based on local policies established by MACs, which are responsible for processing Medicare claims and providing guidance on coverage specifics.
For CPT code 90284, it is essential to verify its inclusion in the MPFS and check with the local MAC to confirm any additional coverage criteria or documentation requirements. This ensures that the service is reimbursed appropriately under Medicare guidelines. Healthcare providers should regularly review updates from both the MPFS and their MAC to stay informed about any changes in coverage or reimbursement policies for CPT code 90284.
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