CPT code 90396 is a specific code used to identify the varicella-zoster immunoglobulin administered via intramuscular injection.
CPT code 90396 is used to describe the administration of varicella-zoster immune globulin (IG) via intramuscular injection. This code is specifically utilized when a healthcare provider administers this immune globulin to a patient to provide passive immunity against the varicella-zoster virus, which is responsible for causing chickenpox and shingles. The immune globulin is typically given to individuals who have been exposed to the virus and are at high risk of severe disease, such as immunocompromised patients or pregnant women. This code is important for billing and documentation purposes, ensuring that the healthcare provider is reimbursed for the administration of this specific treatment.
For CPT code 90396, which pertains to Varicella-zoster immune globulin administered intramuscularly, the following modifiers may be applicable:
1. 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 E/M service is performed in addition to the administration of the immune globulin.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the administration of the immune globulin is distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used if the immune globulin administration is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the immune globulin administration is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although less common for this specific code, this modifier might be used if the administration is part of a repeated diagnostic test scenario.
6. Modifier 99: Multiple modifiers. This is used when two or more modifiers are necessary to describe the service provided.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the service provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 90396 is associated with the administration of varicella-zoster immune globulin intramuscularly. To determine if this specific CPT code is reimbursed by Medicare, one must refer to the Medicare Physician Fee Schedule (MPFS) and consult with the relevant Medicare Administrative Contractor (MAC) for the specific jurisdiction.
The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, not all CPT codes are included in the MPFS, and coverage can vary based on local policies established by MACs. MACs are responsible for processing Medicare claims and have the authority to make determinations on coverage and reimbursement for services within their regions.
For CPT code 90396, it is essential to verify its inclusion in the MPFS and check with the local MAC to confirm whether it is reimbursed by Medicare. This process ensures that healthcare providers are aware of the reimbursement status and can plan their billing practices accordingly.
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