CPT code 90385 is a specific code used to identify the administration of Rh immunoglobulin in a minidose form via injection.
CPT code 90385 is used to describe the administration of a Rh immune globulin (RhIg) minidose given via intramuscular injection. This code is typically utilized in scenarios where a smaller dose of RhIg is required, such as in certain cases of Rh incompatibility during pregnancy. The Rh immune globulin helps prevent the mother's immune system from developing antibodies against Rh-positive blood cells, which is crucial in managing Rh incompatibility and preventing potential complications in future pregnancies.
For CPT code 90385, which pertains to the administration of Rh immune globulin (minidose) via intramuscular injection, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) 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 an E/M service is provided on the same day as the administration of the Rh immune globulin and is distinct from the procedure itself.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the administration of the Rh immune globulin is distinct or independent from other services performed on the same day. It is typically used to prevent bundling of services that are usually considered part of a comprehensive service.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used if the Rh immune globulin administration is 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 Rh immune globulin administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. While not typically used for injections, if the administration is part of a series of tests or treatments, this modifier may be applicable to indicate a repeat service.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided accurately.
These modifiers help clarify the circumstances under which the Rh immune globulin is administered and ensure appropriate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure correct usage.
The CPT code 90385 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS). However, whether this code is reimbursed by Medicare can depend on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region.
MACs are responsible for processing Medicare claims and can have varying local coverage determinations that affect reimbursement. Therefore, it is essential to consult the MPFS and the relevant MAC to determine if CPT code 90385 is reimbursed in your specific area and under your particular circumstances.
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