CPT code 90287 is a unique identifier for the botulinum antitoxin, used to specify this treatment in healthcare documentation and communication.
CPT code 90287 is used to describe the administration of botulinum antitoxin. This code is utilized by healthcare providers to document and bill for the therapeutic use of antitoxin to counteract the effects of botulinum toxin exposure. The botulinum antitoxin is typically administered in cases of suspected or confirmed botulism, a serious illness caused by the botulinum toxin, which can lead to paralysis and other severe symptoms. Proper coding with CPT 90287 ensures that the healthcare provider is reimbursed for the specific service of administering this critical treatment.
For CPT code 90287, which pertains to Botulinum antitoxin, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 22 - Increased Procedural Services: Use this modifier if the administration of the botulinum antitoxin required significantly more work 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: This modifier is used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same provider on the same day as the administration of the antitoxin.
3. Modifier 59 - Distinct Procedural Service: Apply this modifier when the administration of the botulinum antitoxin is distinct or independent from other services performed on the same day. This could be due to a different session, procedure, or site.
4. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: Use this modifier if the botulinum antitoxin administration is repeated on the same day by the same provider.
5. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is applicable if the botulinum antitoxin administration is repeated on the same day by a different provider.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this specific code, if the administration involves repeated laboratory testing on the same day, this modifier may be applicable.
7. Modifier 99 - Multiple Modifiers: Use this modifier when two or more modifiers are necessary to describe the service provided. Documentation should clearly indicate the need for multiple modifiers.
Each modifier should be used in accordance with payer guidelines and supported by appropriate documentation to justify its use.
CPT code 90287, which pertains to Botulinum antitoxin, is subject to reimbursement considerations under Medicare.
To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare and their respective reimbursement rates.
Additionally, it is important to consult with the relevant Medicare Administrative Contractor (MAC) for your region, as MACs are responsible for processing Medicare claims and can provide specific guidance on coverage and reimbursement policies for CPT code 90287.
Each MAC may have unique interpretations and guidelines, so verifying with them ensures compliance and accurate reimbursement.
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