CPT code 90378 is a code used to identify the administration of RSV monoclonal antibody, specifically 50mg, for healthcare services.
CPT code 90378 is used to describe the administration of respiratory syncytial virus (RSV) monoclonal antibody, specifically for a dosage of 50 mg given via intramuscular injection. This code is typically utilized by healthcare providers to document and bill for the preventive treatment of RSV, which is a common respiratory virus that can cause serious illness in infants and high-risk individuals. The use of this code ensures accurate billing and reimbursement for the administration of this specific medication.
For CPT code 90378, which pertains to the administration of RSV monoclonal antibody, intramuscular, 50 mg, 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 patient receives a significant, separately identifiable evaluation and management service on the same day as the administration of the RSV monoclonal antibody.
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 administration of the RSV monoclonal antibody 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 when the same procedure is repeated on the same day by the same provider, which may occur if multiple doses are administered.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. While not typically used for drug administration, this modifier might be relevant if the administration is part of a clinical study requiring repeated tests.
6. Modifier XE: Separate encounter. This modifier is used to indicate that a service was performed during a separate encounter on the same day.
7. Modifier XS: Separate structure. This modifier is used to indicate that a service was performed on a separate organ/structure.
8. Modifier XP: Separate practitioner. This modifier is used to indicate that a service was performed by a different practitioner.
9. Modifier XU: Unusual non-overlapping service. This modifier is used to indicate that a service does not overlap usual components of the main service.
These modifiers help clarify the circumstances under which the RSV monoclonal antibody is administered, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 90378 is associated with a specific service that may be reimbursed by Medicare, but its reimbursement is contingent upon several factors.
To determine if Medicare reimburses this code, it is essential to consult the Medicare Physician Fee Schedule (MPFS), which provides a comprehensive list of services covered by Medicare and their corresponding reimbursement rates.
Additionally, the reimbursement for CPT code 90378 can vary based on the policies of the local Medicare Administrative Contractor (MAC), which administers Medicare claims for specific regions.
Each MAC may have different coverage determinations and guidelines, so it is crucial for healthcare providers to verify with their respective MAC to ensure that CPT code 90378 is reimbursable under Medicare in their area.
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