CPT code 90379 is a medical code used to identify the administration of RSV immunoglobulin intravenously for patient treatment.
CPT code 90379 is used to describe the administration of respiratory syncytial virus immune globulin, intravenous (RSV-IGIV). This code is specifically for the intravenous infusion of immune globulin designed to provide passive immunity against the respiratory syncytial virus (RSV), which is a common cause of respiratory infections in infants and young children. The use of this code is crucial for healthcare providers to accurately document and bill for the administration of this specialized treatment, ensuring proper reimbursement and tracking of patient care services.
For CPT code 90379, which pertains to RSV 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 used when a significant, separately identifiable evaluation and management 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 other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
These modifiers should be used appropriately based on the specific clinical scenario and documentation should support the use of any modifier to ensure accurate billing and reimbursement.
CPT code 90379, which is associated with 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 guidance on whether a particular CPT code, such as 90379, is covered and reimbursed in specific regions. Coverage and reimbursement can vary based on local coverage determinations (LCDs) set by MACs, which consider regional medical necessity and policy guidelines.
Therefore, to ascertain if CPT code 90379 is reimbursed by Medicare, healthcare providers should review the MPFS and consult with their respective MAC for the most accurate and region-specific information.
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