Summary & Overview
CPT 90288: Botulism Immune Globulin Intravenous
CPT code 90288 represents administration of Botulism Immune Globulin Intravenous (BIG–IV), a pooled immunoglobulin product used to provide passive immunity and neutralize circulating botulinum toxin. Nationally, this code is important for acute care billing related to suspected or confirmed botulism, where timely administration can affect clinical outcomes and resource utilization. The code applies primarily to inpatient and acute care settings where intravenous infusion and monitoring are available.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing context for BIG–IV, how the service is typically documented, and the clinical scenarios that prompt use of this product. The publication outlines reimbursement and coverage considerations across major payers, common modifier use observed in claims, and operational implications for hospitals and infusion centers. It also provides clinical context about the product’s role in neutralizing botulinum toxin and the expected site-of-service patterns. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 90288 describes administration of Botulism Immune Globulin Intravenous (BIG–IV), a pooled immunoglobulin product derived from plasma of adults immunized with pentavalent botulinum toxoid. The product provides passive immunity against botulinum toxin and is used to neutralize circulating toxin in affected patients.
Service type: Intravenous immunoglobulin therapy for botulism neutralization.
Typical site of service: Inpatient hospital or acute care facility, where intravenous administration and monitoring for an acute neuroparalytic illness are available.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pediatric patient aged 4 months presents to the emergency department with acute onset of hypotonia, poor feeding, weak cry, and cranial nerve findings after suspected exposure to home-canned foods. Examination raises concern for infant botulism. Clinicians obtain history and quickly evaluate for respiratory compromise and need for airway support. After clinical confirmation and consultation with infectious disease and pediatric critical care, Botulism Immune Globulin Intravenous (BIG–IV) is ordered and administered intravenously by an experienced infusion nurse in an inpatient pediatric ward or pediatric intensive care unit. Monitoring includes baseline and serial respiratory assessments, pulse oximetry, and observation for infusion reactions. Documentation includes indication (suspected or confirmed botulism), weight-based dosage, lot number, informed consent, start and stop times, IV site and route, and any adverse events. Billing uses 90288 to report administration of the immunoglobulin product itself; facility and professional components, infusion supplies, and critical care or respiratory support are billed separately per usual institutional practice.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard primary procedure | Rarely used as a modifier; indicates no modifier applies when required by payer. |