CPT 90375: Rabies Immunoglobulin for Post-Exposure Passive Immunity
CPT code 90375 identifies rabies immunoglobulin (RIg), a human plasma–derived gamma globulin preparation with high titers of rabies antibodies used for passive immunization after category III rabies exposures. Nationally, RIg is a critical component of rabies post-exposure prophylaxis because it provides immediate neutralizing antibodies until active immunity from rabies vaccination develops. Access to and coverage of RIg affect emergency care pathways and public health responses to potential rabies exposures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for 90375, typical sites of service, and payer coverage considerations. The publication outlines benchmarking metrics relevant to utilization and reimbursement, highlights policy updates that influence coverage and coding practice, and summarizes clinical implications for delivering timely post-exposure prophylaxis. Where input data are incomplete, the report notes that specific details are not available in the input and focuses on nationally relevant guidance and interpretation rather than jurisdictional specifics.
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Billing Code Overview
CPT code 90375 describes rabies immunoglobulin (RIg) derived from pooled human plasma with high-titer antibodies to rabies virus. This biologic provides passive immunity and is used for prevention or treatment of category III rabies exposures, supplying immediate antibodies to neutralize virus at the exposure site.
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Service type: Administration of a human-derived immunoglobulin product for post-exposure prophylaxis
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Typical site of service: Emergency department, inpatient facility, urgent care center, or outpatient infusion clinic where rabies post-exposure treatment is provided
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 32-year-old unvaccinated adult presents to the emergency department after a category III exposure: a deep transdermal bite to the forearm by a stray dog while traveling in a rabies-endemic area. Wounds are irrigated and cleansed; tetanus status is verified. Because the patient has not previously received rabies vaccine, passive immunization with human rabies immune globulin is indicated and administered as a single infiltrative dose around the wound and any residual volume given intramuscularly. The typical clinical workflow includes wound care, risk assessment for rabies exposure, informed consent, calculation of the immune globulin dose based on body weight, local infiltration of as much as anatomically feasible into and around the wound, and documentation of lot number, dose, route, site, time, and supervising clinician.
Typical site of service is an emergency department, urgent care clinic, or hospital outpatient infusion/ procedural area. The procedure is performed by emergency medicine physicians, infectious disease specialists, or other credentialed clinicians (physicians, physician assistants, or nurse practitioners) trained to administer immunoglobulin and manage post-exposure prophylaxis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed and documented separately from the immunoglobulin administration (e.g., history, exam, decision-making for PEP). |
59 | Distinct procedural service | Use if multiple distinct procedures are reported the same day and distinct procedural work is documented separate from the immune globulin administration. |
52 | Reduced services | Use when the billed service is partially reduced or not completed as documented (rare for full-dose immunoglobulin). |
53 | Discontinued procedure | Use if immunoglobulin administration was started but discontinued for documented medical reasons. |
76 | Repeat procedure by same physician | Use if the same clinician administers an additional dose on the same day (uncommon for 90375). |
77 | Repeat procedure by another physician | Use if another clinician repeats the administration on the same day. |
JZ | Drug administered is single-dose container and no wastage | Use when no drug wastage occurs for documentation and billing of the supplied product. |
JW | Drug discarded/unused portion of a single-dose vial | Use when a measurable portion of the vial is discarded; supports billing adjustments where allowed. |
ER | Emergency service | Use when service is furnished in an emergency department setting (facility-level reporting if required). |
TC | Technical component | Use when billing facility technical component separately (facility bills TC, provider bills 26 if applicable). |
26 | Professional component | Use when billing the professional component separate from the facility charge, if applicable. |
59 | Distinct procedural service | Use to indicate a separate and distinct service when multiple services are coded the same date (duplicate intentionally listed to emphasize frequent applicability). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207P00000X | Emergency Medicine Physician | Common clinician administering rabies immune globulin in ED settings. |
208000000X | Family Medicine Physician | May provide wound care and administer PEP in urgent care or clinic settings. |
208D00000X | Infectious Disease Specialist | Consulted for complex exposures, immunocompromised patients, or vaccine scheduling. |
363LF0000X | Registered Nurse | Often performs preparation and administration under protocol. |
363LA2200X | Physician Assistant | Frequently assists with wound infiltration and administration under supervising physician. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A82.9 | Rabies, unspecified | Direct diagnosis indicating rabies exposure or infection risk prompting passive immunization. |
Z20.822 | Contact with and (suspected) exposure to rabies | Indicates documented exposure to rabies virus; supports need for rabies PEP including immunoglobulin. |
S01.812A | Puncture wound with foreign body of right forearm, initial encounter | Example wound code for a bite injury that may require local infiltration with rabies immunoglobulin. |
S61.219A | Unspecified open wound, left wrist, initial encounter | Representative code for open wounds from animal bites requiring local treatment and RIG. |
Z23 | Encounter for immunization | Used to document administration of biologic prophylaxis as part of preventive care workflow. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance) | Used for intramuscular administration of immunoglobulin when billed separately from the drug code; documents injection administration service. |
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Used if immunoglobulin is delivered via IV infusion rather than local wound infiltration or IM. |
90471 | Immunization administration (single) by intramuscular, intradermal or subcutaneous injection | Alternative administration code for vaccine/biologic injections when applicable documentation supports use. |
99070 | Supplies and materials (e.g., drugs, sutures) provided by the physician over and above those usually included with the office visit | Used for additional non-billable supplies related to wound care or administration not included elsewhere. |
96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | May be reported when concurrent IV fluids are administered during the immunoglobulin infusion. |