CPT 90287: Botulism Antitoxin, Equine-Derived Globulin
CPT code 90287 designates Botulism Antitoxin, an equine-derived, enzymatically modified globulin preparation used to neutralize circulating botulinum toxin. Nationally, this code represents a critical acute-care biologic with implications for emergency and inpatient treatment protocols, supply chain management, and payer coverage for high-cost, lifesaving therapies. Its use is episodic but clinically urgent, making accurate coding and timely authorization important for hospitals and emergency providers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the product, typical sites of service, payer coverage considerations, and benchmarking content where available. The publication outlines coding specifics for billing teams, outlines common modifiers and administrative notes provided in the input, and highlights gaps where data are not available.
This summary is intended for billing managers, hospital administrators, and clinicians involved in acute care delivery and revenue cycle operations who need a clear, national-level reference on CPT code 90287 and its role in botulism treatment.
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Billing Code Overview
CPT code 90287 describes Botulism Antitoxin, a refined and concentrated liquid preparation of horse (equine) globulins that have been modified by enzymatic digestion. This product is used to neutralize circulating botulinum toxin in patients with suspected or confirmed botulism.
Service type: Antitoxin biologic administration / passive immunotherapy
Typical site of service: Hospital inpatient or emergency department where acute neutralization of toxin is required and intravenous administration and monitoring can be provided.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves an emergency department or inpatient adult patient presenting with suspected botulism — progressive, symmetric cranial nerve palsies (diplopia, dysarthria, dysphagia), descending flaccid paralysis, and/or respiratory compromise after foodborne exposure, wound contamination, or injection drug use. After clinical suspicion is established by the emergency physician, neurologist, or infectious disease specialist, public health authorities and the treating team coordinate rapid procurement and administration of botulism antitoxin to neutralize circulating neurotoxin.
The clinical workflow commonly includes: initial triage and airway assessment; neurologic examination documenting cranial nerve and motor deficits; supportive measures (airway protection, mechanical ventilation if needed); notification of local or state public health for antitoxin release; informed consent discussion with the patient or surrogate; intravenous administration of the antitoxin in a monitored setting (ED, ICU, or inpatient ward) with readiness to manage hypersensitivity reactions; post-administration monitoring for allergic/anaphylactic events and ongoing supportive care including respiratory and nutritional management. Documentation should include time of symptom onset, neurologic findings, indication for antitoxin, lot number and dose of 90287 administered, consent, and any adverse reactions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard reporting / no modifier | Use when no special circumstances apply to the administration of 90287. |
52 | Reduced services | Use if only a partial dose or limited administration of antitoxin occurred and the service was intentionally reduced. |
53 | Discontinued procedure | Use if administration was started but discontinued due to patient deterioration or adverse event prior to completion. |
55 | Postoperative management only | Rare for this code; use when only subsequent post-administration management services are reported separately by the administering provider. |
56 | Preoperative management only | Rarely applicable; use if the provider billed only pre-administration evaluation services distinct from the antitoxin administration. |
SL | State-supplied vaccine/biological | Use when the antitoxin is supplied at no charge by a public health authority and billing is adjusted per payer rules. |
24 | Unrelated E/M by same physician | Use when an unrelated evaluation is provided on the same day as 90287 administration (if applicable and recognized by payer). |
25 | Significant, separately identifiable E/M service | Use when a significant E/M is performed on the same day as antitoxin administration that is distinct from the procedure-related care. |
59 | Distinct procedural service | Use to indicate a service distinct from other procedures on the same day when payer edits would bundle them. |
AE | Transplant-related service | Not typical, but use if administration relates to transplant protocol and payer recognizes the modifier. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RG0100X | Emergency Medicine | ED physicians commonly identify and initiate antitoxin administration. |
2080P0207X | Neurology | Neurologists confirm diagnosis and guide neurologic monitoring and indications. |
207L00000X | Infectious Disease | ID specialists coordinate diagnosis, antitoxin indications, and public health reporting. |
207L00000X | Critical Care Medicine | Intensivists manage airway, ventilation, and hemodynamic support during and after administration. |
3336C0005X | Pharmacy | Hospital pharmacists prepare and document biologic handling, lot numbers, and compatibility. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A05.1 | Botulism | Primary diagnostic code for foodborne or wound botulism prompting use of 90287. |
A48.01 | Botulism, infant | Infant botulism indication for antitoxin therapy; dosing and source coordination differ by age. |
A48.02 | Botulism, other unspecified | Used when botulism is diagnosed but subtype (foodborne, wound) is not classified elsewhere. |
T63.442A | Toxic effect of bacterial toxins, initial encounter | May be used when documenting systemic toxic effects related to botulinum toxin exposure. |
R13.10 | Dysphagia, unspecified | Symptom-related code documenting swallowing impairment that supports clinical need for antitoxin and supportive care. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Often performed prior to 90287 to obtain baseline labs (CBC, CMP, blood gases) and confirm supportive care needs. |
93010 | Electrocardiogram interpretation and report only | May be performed to monitor cardiac conduction changes in patients with autonomic involvement. |
94640 | Pressurized or non-pressurized inhalation treatment for acute airway obstruction | Used for respiratory symptomatic management; may be part of supportive care but not a substitute for antitoxin. |
31500 | Intubation, endotracheal, emergency procedure | Performed if respiratory failure occurs before or after antitoxin administration; part of airway management in the same clinical episode. |
99223 | Initial hospital care, typically 70 minutes or more | Represents initial critical inpatient evaluation and management for severely affected patients receiving 90287 during admission. |