CPT code 90375 is a specific code used to identify the rabies immunoglobulin administered via intramuscular or subcutaneous injection.
CPT code 90375 is used to describe the administration of rabies immune globulin, which is given either intramuscularly (IM) or subcutaneously (SC). This code is specifically utilized for billing purposes when a healthcare provider administers rabies immune globulin to a patient, typically as a preventive measure following potential exposure to the rabies virus. The immune globulin provides immediate, short-term protection by supplying antibodies that help neutralize the virus, complementing the longer-term protection offered by the rabies vaccine.
For CPT code 90375, which pertains to the administration of rabies immune globulin either intramuscularly or subcutaneously, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed in addition to the administration of the rabies immune globulin.
2. 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 applicable if the rabies immune globulin administration is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the rabies immune globulin administration needs to be repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is applicable if the rabies immune globulin administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for immunoglobulin administration, this modifier might be relevant if the administration is part of a diagnostic test that needs to be repeated.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided. It indicates that multiple modifiers are applicable to the procedure.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for modifier usage.
The CPT code 90375 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies of the Medicare Administrative Contractor (MAC) in your specific region.
The MPFS provides a list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, not all CPT codes are included in the MPFS, and some may be subject to local coverage determinations (LCDs) by the MACs.
These contractors have the authority to decide whether a particular service is reasonable and necessary, and thus eligible for reimbursement, based on regional needs and practices.
Therefore, to determine if CPT code 90375 is reimbursed by Medicare, healthcare providers should consult the MPFS and check with their local MAC for any specific coverage guidelines or restrictions.
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