CPT code 90291 is a medical code used to identify the administration of CMV immunoglobulin intravenously for patient treatment.
CPT code 90291 is used to describe the administration of cytomegalovirus immune globulin intravenously (CMV IGIV). This code is specifically for the infusion of a specialized immune globulin product that is used to help prevent or treat cytomegalovirus (CMV) infections, particularly in patients who are at high risk, such as those who have undergone organ transplants. The immune globulin contains antibodies that can help bolster the immune system's response to CMV, thereby reducing the risk of infection or mitigating its effects. This code is utilized by healthcare providers to accurately document and bill for the administration of this specific therapeutic procedure.
For CPT code 90291, which pertains to CMV immune globulin intravenous, 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: This modifier is applicable when a significant, separately identifiable E/M 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: This modifier is used when it is necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.
These modifiers should be used in accordance with the specific guidelines and payer policies, ensuring that documentation supports the use of each modifier. Proper use of modifiers can help in accurate billing and reimbursement processes.
CPT code 90291, which pertains to a specific medical service, is subject to reimbursement considerations under Medicare. To determine if this code is reimbursed by Medicare, it is essential to consult the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with their respective reimbursement rates.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific guidance on whether CPT code 90291 is reimbursed. They may have Local Coverage Determinations (LCDs) that specify coverage criteria for certain services, including those represented by CPT codes.
Therefore, to ascertain if CPT code 90291 is reimbursed by Medicare, healthcare providers should review the MPFS and consult their respective MAC for any specific coverage policies or requirements.
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