CPT 90376: Rabies Immunoglobulin (Human) for Post-Exposure Prophylaxis
CPT code 90376 represents rabies immunoglobulin derived from pooled human plasma, used to provide passive immunity for category III rabies exposures. This code is critical for billing administration of biologic immune globulin in post‑exposure prophylaxis and acute management, as timely administration can prevent fatal rabies infection.
Key national payers typically involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization requirements can affect access and site‑of‑care decisions across hospital, emergency department, urgent care, and ambulatory infusion settings.
Readers will find a concise overview of the clinical context and coding purpose, payer coverage landscape, and the types of operational benchmarks and policy considerations that commonly accompany high‑cost, time‑sensitive biologic therapies. The publication summarizes clinical indications tied to the code, typical sites of service where 90376 is billed, common billing modifiers (listed separately), and guidance on where input data is not available. This national summary is designed to inform coding staff, revenue cycle managers, and clinical leaders about the role of CPT code 90376 in post‑exposure rabies care and billing workflows.
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Billing Code Overview
CPT code 90376 describes rabies immunoglobulin (human), a preparation of pooled human gamma globulin with high titers of antibodies to the rabies virus used to provide passive immunity. These products are used for post‑exposure prophylaxis and treatment of category III rabies exposures to neutralize virus at the wound site and provide immediate antibody protection.
Service type: Passive immunotherapy / biologic blood product administration
Typical site of service: Hospital inpatient or outpatient settings, emergency departments, urgent care clinics, and ambulatory infusion centers
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a previously unvaccinated adult or child presenting after a high‑risk animal bite or other exposure consistent with category III rabies exposure (transdermal bite, contamination of mucous membrane with saliva, or multiple severe bites). The patient arrives to the emergency department or urgent care clinic; triage documents the exposure mechanism, wound severity, and timing. The clinician assesses tetanus status, performs wound cleansing and closure as indicated, and determines rabies post‑exposure prophylaxis is required. Rabies immunoglobulin (90376) is calculated by weight (human rabies immunoglobulin), infiltrated around wounds when feasible, with any remaining volume administered intramuscularly at a distant site, and given once at initiation of post‑exposure prophylaxis together with rabies vaccine series. Typical sites of service are hospital emergency departments, urgent care centers, outpatient clinics with immunization capability, and public health clinics. The clinical workflow includes patient assessment, informed consent, weight‑based dose calculation, wound infiltration technique, documentation of lot and expiration numbers, observation for immediate adverse reaction, and scheduling of vaccine doses for completion of prophylaxis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard submission when no modifier applies |
22 | Increased procedural services | When unusually extensive infiltration or time was required beyond typical administration |
23 | Unusual anesthesia | Not typically applicable but used if general anesthesia was required for infiltration |
52 | Reduced services | If only partial dose administered due to adverse event or patient refusal |
53 | Discontinued procedure | If administration was begun but stopped prior to completion for medical reasons |
62 | Two surgeons | Rare — when two qualified clinicians jointly perform complex wound management with infiltration |
78 | Return to operating/procedure room for a related procedure following initial administration | If patient requires return for additional wound exploration and repeat local infiltration in OR setting |
80 | Assistant surgeon | If an assistant surgeon is documented and billable for the procedure in the operative setting |
JW | Drug discarded/not administered to patient | If a portion of the vial is discarded and not administered due to contamination or breakage; documents wasted drug |
JZ | No wasted drug to be discarded | When entire dispensed unit(s) were administered with no waste |
QK | Monoclonal antibody drug limited distribution | Not typically applicable to human rabies immunoglobulin but included if limited distribution applies |
QX | Qualified non‑physician practitioner | When a qualified NP or PA administers under appropriate supervision and billing rules require this modifier |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | If these practitioners assist in a surgical setting involving wound repair and infiltration |
TB | 0–72 hours neonatal blood transfusion | Rare and generally not applicable; included when neonatal exposures require special coding |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 208D00000X | Emergency Medicine | Most common providers performing acute rabies immunoglobulin administration in ED settings |
| 363LF0000X | Immunology (Clinical) | Specialists involved in management of complex immunoglobulin therapies and adverse reactions |
| 207P00000X | Family Medicine | Primary care or urgent care clinicians providing post‑exposure prophylaxis in outpatient clinics |
| 207L00000X | Infectious Disease | Consulted for complex exposures, immunocompromised patients, or vaccine‑immunoglobulin interactions |
| 209K00000X | Pediatric Medicine | Pediatricians or pediatric emergency medicine providers for children requiring weight‑based dosing |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z20.3 | Contact with and (suspected) exposure to rabies | Primary exposure screening code used when patient presents after potential rabies exposure and consideration for immunoglobulin is required |
W54.0 | Bitten by dog | Common mechanism of exposure leading to consideration of rabies immunoglobulin in unvaccinated patients |
W55.32 | Contact with other mammals (bite) | Captures bites from wild mammals (e.g., raccoon, bat) that commonly prompt rabies prophylaxis |
W53.2 | Bitten by bat | Specific animal exposure with high rabies risk; often triggers rabies immunoglobulin and vaccine series |
T14.90 | Injury, unspecified, part of body unspecified | Used when a bite wound is present but specific anatomical detail is not yet coded; supports treatment including immunoglobulin when combined with exposure code |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
A9270 | Non‑covered item or service (used for reporting certain immunoglobulin products) | Often used by payors for reporting or tracking of rabies immunoglobulin products when specific HCPCS is required; administrative relation to drug billing (note: A9270 is a HCPCS miscellaneous code) |
90471 | Immunization administration (single) by intramuscular injection | Used when rabies immunoglobulin or vaccine is administered intramuscularly and separate administration code is reportable |
90472 | Immunization administration (each additional) | Used for additional vaccines administered during the same encounter (for vaccine series or multiple injections) |
90460 | Immunization administration through 18 years of age; with counseling by physician or other qualified health care professional | When counseling accompanies vaccine/immunoglobulin administration for pediatric patients |
11042 | Debridement, subcutaneous tissue (simple) | May be performed prior to local infiltration if wound requires debridement in the ED or OR setting |
99283 | Emergency department visit, moderate complexity | Typical E/M code billed for ED encounters where rabies immunoglobulin is administered; relates to initial clinical evaluation and management |