Tuesday, August 10, 2010

Billing CPT G0281 Immune Globulin

Coding for Immune Globulins, Vaccines and Toxoids

CPT-Codes (Current Procedural Terminology) are assigned by the AMA and used to bill for Immune Globulins, Vaccines and Toxoids.


Immune Globulins: Products listed include broad-spectrum and anti-infective immune globulins, antitoxins, and various isoantibodies;
Vaccines/Toxoids: Multiple codes for a particular vaccine/toxoid are provided when the schedule (number of doses or timing) differs for two or more products of the same vaccine type (e.g., hepatitis A, HiB) or the vaccine product is available in more than one chemical formulation, dosage, or route of administration. Separate codes are available for combination vaccines (e.g., DTP-Hib, DtaP-Hib, and HepB-Hib). It is inappropriate to code each component of a combination vaccine separately. If a specific vaccine, toxoid or immune globulin code is not available, the unlisted CPT® code 90749 (vaccines/toxoids) or 90399 (immune globulins) should be reported, until a new code becomes available.

Reimb CodeDescriptionEffective DateCode PriceCode Price-5%
90281Immune Globulin (Ig), human, for intramuscular use (Code price is per 2 mL)10/01/09$38.83$36.89

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download