Summary & Overview
CPT 90378: Respiratory Syncytial Virus Immune Globulin, Intramuscular
CPT code 90378 represents intramuscular respiratory syncytial virus immune globulin (RSV–IgIM), a human hyperimmune immunoglobulin preparation used to provide passive immunity against RSV. This biologic product is clinically important for protecting high-risk infants and other vulnerable populations from severe RSV infection and is billed separately when administered intramuscularly. National attention on 90378 stems from its role in preventive care for at-risk patients and the billing considerations associated with specialty biologics.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact review of the code’s clinical context and common sites of service, plus guidance on the types of benchmarks and policy issues typically relevant to this code: coverage policies, medical necessity criteria, and billing practices for intramuscular immune globulin products. Where specific payer policy details or comparative benchmarks are required, those items are identified as areas for further lookup, since beneficiary eligibility, prior authorization requirements, and coverage criteria can vary across payers.
This summary serves clinicians, billing staff, and policy analysts who need a clear characterization of CPT code 90378, its clinical purpose, and the payer landscape to inform billing, coding, and coverage inquiries at a national level.
Billing Code Overview
CPT code 90378 describes respiratory syncytial virus immune globulin (RSV–IgIM), intramuscular, a human hyperimmune immunoglobulin preparation derived to provide passive immunity against RSV. The product is a concentrated immunoglobulin indicated to deliver targeted antibodies for short-term protection against RSV infections.
Service Type: Intramuscular immune globulin administration
Typical Site of Service: Outpatient clinic or physician office; ambulatory care settings where intramuscular injections are administered
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Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child with high risk for severe respiratory syncytial virus (RSV) infection — for example, a premature infant or a child with chronic lung disease of prematurity or significant congenital heart disease. The clinical workflow begins in an outpatient pediatric clinic, neonatal follow-up program, or hospital pediatric infusion area. After review of the patient’s medical history and confirmation of eligibility for passive immunization, the provider documents indication, informed consent, and any contraindications (such as IgA deficiency with antibodies). A licensed clinician prepares and administers 90378 (RSV immune globulin, intramuscular) using aseptic technique, typically in the anterolateral thigh or deltoid depending on patient age and size. Observation for immediate adverse reactions occurs for a short period post-injection. Documentation includes the product lot number, dosage, route, site of administration, and patient response. Billing uses 90378 for the RSV–IgIM product with appropriate diagnosis linkage to the patient’s high-risk condition and any applicable modifier(s) to denote professional or technical aspects, unusual circumstances, or payment adjustments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug or biological amount discarded/unused |