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.
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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. |
22 | Increased procedural services | Use when administration required substantially greater resources or complexity (e.g., difficult vascular access, prolonged monitoring due to severe anaphylaxis risk). |
23 | Unusual anesthesia | Use if general anesthesia is medically necessary for safe administration in a patient who cannot be safely positioned or immobilized. |
26 | Professional component | Use when billing separately for physician professional interpretation or services associated with the administration if payer requires split billing. |
52 | Reduced services | Use when only partial dose or abbreviated administration occurs (e.g., infusion stopped due to severe reaction and not completed). |
53 | Discontinued procedure | Use when administration is initiated but halted due to intolerable adverse event and service is discontinued. |
62 | Two surgeons | Use when two qualified practitioners are required during complex airway or vascular access procedures concurrent with administration. |
78 | Return to the operating room for a related procedure following the initial service | Use if patient requires surgical revision or re-intervention related to complications of administration. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services in facility | Use when a PA/NP/CNS performs or assists with the administration under appropriate state law and payer rules. |
QX | Ordering physician is also the rendering/performing physician (modifier for CLIA)? | Use when specific payer rules require documentation that the ordering and performing clinicians are the same and modifier is accepted for the immunoglobulin service. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208000000X | Pediatrics | Pediatricians commonly coordinate diagnosis and ordering of 90288 for infant botulism. |
| 207Q00000X | Pediatric Critical Care Medicine | Pediatric intensivists manage infusion in an ICU setting with respiratory support. |
| 207K00000X | Infectious Disease | Infectious disease specialists confirm indication and dosing for botulism immune globulin. |
| 363A00000X | Pediatric Nurse Practitioner | Advanced practice nurses often perform or supervise infusion and monitoring. |
| 364S00000X | Registered Nurse | Infusion and bedside monitoring are delivered by RNs experienced in pediatric IV immunoglobulin administration. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Used to report the infusion administration time when BIG–IV is administered via IV infusion and facility/payer requires separate reporting of infusion services. |
96366 | Intravenous infusion, each additional hour (List separately in addition to code for primary infusion) | Use when infusion of BIG–IV extends beyond the first hour and additional infusion time must be reported. |
36415 | Collection of venous blood by venipuncture | May be performed for baseline labs prior to infusion (e.g., CBC, CMP) and is billed separately. |
31500 | Intubation, endotracheal, emergency procedure | Performed if respiratory failure occurs requiring airway management prior to or during administration; billed separately. |
99223 | Initial hospital care, typically 70 minutes or more | Represents initial inpatient evaluation and management by a physician when the patient is admitted for botulism treatment and infusion with 90288. |