CPT 90291: Cytomegalovirus Immune Globulin (CMV–IgIV) Infusion
CPT code 90291 denotes administration of Cytomegalovirus immune globulin (CMV–IgIV), a pooled human immunoglobulin product used to provide passive immunity against CMV. This code is relevant nationally for hospitals, infusion centers, transplant programs, and specialty clinics that manage immunocompromised patients at risk for CMV infection. Claims for immune globulin products carry clinical and billing complexity because dosing, indication, and site of service affect utilization and payer policies.
Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for CMV–IgIV use, typical sites of service, and what to expect in payer coverage patterns. The publication summarizes benchmarks where available, highlights typical billing considerations such as common modifiers, and outlines policy and coding issues that influence claims processing and reimbursement. This resource is intended to help coding, billing, and clinical teams understand the role of CPT code 90291 in immunoglobulin therapy workflows and payer interactions, and to provide a concise reference to support accurate claim submission and administrative planning.
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Billing Code Overview
CPT code 90291 describes administration of Cytomegalovirus immune globulin (CMV–IgIV), a pooled human immunoglobulin preparation used to provide passive immunity against cytomegalovirus (CMV). The product is derived from adult plasma and contains complex immunoglobulin proteins intended to neutralize or modify CMV infection risk.
Service type: Intravenous immune globulin therapy for CMV prophylaxis or treatment.
Typical site of service: Hospital outpatient infusion center, inpatient hospital setting, or specialized infusion clinic.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a solid-organ transplant recipient (for example, lung or liver transplant) who receives intravenous Cytomegalovirus immune globulin (CMV–IgIV) as part of prophylaxis or early treatment to prevent or mitigate cytomegalovirus infection. The clinical workflow begins with identification of CMV serostatus (donor and recipient), assessment of risk (D+/R- highest risk), and an order for passive immunoprophylaxis when indicated. The patient usually presents to an outpatient infusion center, hospital outpatient department, or inpatient ward. Prior to infusion, nursing documents informed consent, verifies identity and allergies, and checks baseline vital signs and intravenous access. Pharmacy compounds or dispenses the pooled immunoglobulin product per manufacturer instructions; the product is labeled and may require the JW modifier if discarded partial doses are billed. During infusion, nursing monitors for infusion reactions and documents administration time, lot number, and volume infused. Post-infusion, vital signs and adverse event monitoring continue; documentation includes clinical indication, dose, route, lot numbers, and any infusion-related events. Billing is submitted for the administered immune globulin using 90291 with appropriate modifiers as indicated by payor rules and clinical circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | Use when a portion of the single-use immunoglobulin vial is wasted and the payor requires reporting of discarded drug. |
QK | Intravenous infusion of blood-derived products; per diem for each additional administration | Use per payor policy for billing supplemental units when applicable to blood product infusion reporting (check payor-specific guidance). |
QX | CLIA-waived laboratory practitioner's services | Rarely used directly with 90291; include only when a CLIA-waived practitioner performed a billable related lab service tied to the encounter per payor rules. |
QY | Patient provided home infusion drug services | Use when the immunoglobulin is administered in the patient’s home under a qualified home infusion program, as allowed by payor. |
52 | Reduced services | Use when the full dose or full planned administration was not completed and the service rendered was reduced. |
53 | Discontinued procedure | Use when the infusion was started but discontinued due to an adverse reaction and documentation supports safe discontinuation. |
78 | Unplanned return to operating/procedure room by same physician following initial procedure | Use only if there is an unplanned return for a related invasive procedure; rarely applicable to 90291. |
80 | Assistant surgeon | Use when an assistant surgeon participates in a related surgical procedure that led to administration of immunoglobulin (applicable to concurrent surgical services). |
62 | Two surgeons | Use when two surgeons of different specialties share responsibility for a related operative case during which immunoglobulin was administered. |
22 | Increased procedural services | Use when the immunoglobulin administration required significantly greater work or resources than typical (document justification). |
23 | Unusual anesthesia | Use when the procedure required general anesthesia or unexpected anesthesia for the administration encounter. |
56 | Discontinued surgery prior to anesthesia | Use when immunoglobulin billing occurs in context of a planned procedure that was canceled prior to anesthesia but other services were rendered. |
JW | (listed above) Duplicate entries for JW are not repeated; it is clinically relevant and included once. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
353600000X | Transplant Surgeon | Performs organ transplant surgeries and coordinates perioperative prophylaxis including CMV immune globulin. |
208100000X | Hematology & Oncology | Manages immunodeficiencies, transplant-related infections, and IV immunoglobulin therapy. |
207L00000X | Infectious Disease | Directs infectious prophylaxis and treatment decisions for CMV in high-risk patients. |
163W00000X | Allergy & Immunology | Manages antibody deficiency and immunoglobulin indications and dosing. |
251S00000X | Critical Care Medicine | Oversees inpatient management when immunoglobulin is given in critically ill transplant patients. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B25.9 | Cytomegalovirus disease, unspecified | Primary diagnosis for active CMV disease where CMV immune globulin may be used as adjunctive therapy. |
Z94.0 | Kidney transplant status | Transplant recipients are high-risk for CMV; prophylactic CMV–IgIV may be used in select cases. |
Z94.1 | Heart transplant status | Heart transplant patients may receive CMV prophylaxis with immune globulin depending on risk. |
Z94.2 | Lung transplant status | Lung transplant recipients commonly receive CMV prophylaxis; CMV–IgIV can be part of the regimen. |
D80.9 | Immunodeficiency disorder, unspecified | Primary or secondary immunodeficiency states can indicate passive immunoglobulin administration for infection prevention. |
T86.10 | Unspecified complication of kidney transplant | Post-transplant complications with infectious risk may prompt use of CMV immune globulin. |
B20 | Human immunodeficiency virus [HIV] disease | Advanced immunosuppression increases risk for CMV; immune globulin may be considered adjunctively in certain scenarios. |
Z79.899 | Other long term (current) drug therapy | Used when documenting ongoing prophylactic therapies including long-term immunoglobulin regimens. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Commonly performed before 90291 for baseline labs (CMV serology, CBC, chemistries) to guide therapy. |
96365 | Intravenous infusion, initial, up to 1 hour | Used when an IV infusion service is billed for administration of biologic products; may be billed alongside or in coordination with 90291 per payor rules. |
90282 | Hepatitis B immune globulin administration | Represents other immune globulin product codes; listed as a related biologic administration code for cross-reference in billing workflows. |
99070 | Supplies and materials (non-covered) | Used to bill ancillary supplies used during infusion (IV tubing, flushes) when payor allows. |
36416 | Collection of capillary blood specimen | May be used for point-of-care testing associated with the infusion encounter. |