Summary & Overview

CPT 90385: Rho(D) Immunoglobulin to Prevent Hemolytic Disease of the Newborn

CPT code 90385 denotes Rho(D) (Rhesus D) immunoglobulin, a plasma‑derived passive immunization product used to prevent maternal alloimmunization and hemolytic disease of the newborn. Nationally, this code captures a critical obstetric prophylactic intervention administered when Rh‑negative individuals are exposed to Rh‑positive blood, such as after delivery, miscarriage, certain prenatal procedures, or trauma. Its use supports neonatal safety and reduces severe morbidity from hemolytic disease.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 90385, typical sites where the product is administered, and which payers commonly reimburse the service. The publication summarizes reimbursement benchmarks and coverage patterns, highlights common billing practice considerations associated with administration in obstetric and outpatient infusion settings, and notes areas where policy language affects access and billing (e.g., coverage criteria tied to obstetric events).

This summary is intended for clinicians, billing professionals, and policy analysts seeking a national perspective on clinical use, payer coverage, and the operational settings tied to CPT code 90385. Data not available in the input are identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 90385Rho(D) immunoglobulinobstetric prophylaxispassive immunityhemolytic disease of the newbornbiologic therapyinfusion clinicmaternal-fetal medicine

Billing Code Overview

CPT code 90385 describes Rho(D) (Rhesus D) immunoglobulin derived from the plasma of immunized human donors and used to provide passive immunity to prevent Rhesus disease (hemolytic disease of the newborn). This biologic preparation supplies anti‑Rhesus D antibodies to susceptible individuals to prevent maternal alloimmunization after exposure to Rhesus D antigen.

Service type: Administration of Rho(D) immunoglobulin as passive immune prophylaxis
Typical site of service: Obstetric or outpatient clinical settings, including labor and delivery units, prenatal clinics, and outpatient infusion or injection clinics

Clinical & Coding Specifications

Clinical Context

A pregnant Rh-negative patient presents for routine prenatal care at 28 weeks gestation after a routine antibody screen shows no anti-D antibodies. The obstetrician documents that the patient’s partner is Rh-positive or paternal status is unknown, and orders Rho(D) immune globulin administration to prevent alloimmunization. The clinical workflow includes verification of maternal blood type and antibody screen, informed consent discussion, verification of prior Rho(D) immune globulin administrations (antepartum or postpartum), preparation of the correct Rho(D) product, intramuscular administration (typically in deltoid or gluteal muscle), documentation of lot number and volume, and postadministration observation for immediate adverse reaction. Additional scenarios include postpartum administration within 72 hours after delivery of an Rh-positive neonate, administration after invasive procedures (amniocentesis, chorionic villus sampling), after spontaneous or induced abortion, or after third-trimester bleeding events. Billing uses 90385 for Rho(D) immune globulin product; administration may be billed separately depending on payer rules and setting. Typical sites of service include outpatient obstetric clinics, labor and delivery units, emergency departments, and infusion centers.

Coding Specifications

Modifier	Description	When to Use
`00`	Default; no modifier	Use when no other modifier applies to the service billed with `90385`.
`22`	Increased procedural services	Use when significant additional work is required for complex counseling or extended time related to Rho(D) immunoglobulin administration (rare for product code).
`23`	Unusual anesthesia	Generally not applicable to `90385`; only used if unusual anesthesia is required for a related procedure.
`52`	Reduced services	Use if a partial dose or abbreviated service occurs (for example, documented partial administration of product).
`53`	Discontinued procedure	Use when ordered administration was started but stopped for patient safety before completion.
`55`	Postoperative management only	Not typically used for `90385`; may apply if related to a surgical episode where only postoperative management is billed.
`62`	Two surgeons	Not typically applicable; leave off for isolated `90385` administration.
`78`	Return to OR for related procedure	Not applicable to standard Rho(D) product administration.
`80`	Assistant surgeon	Not typically used for this service.
`JW`	Drug discarded/amount discarded	Use when part of a single-use Rho(D) vial is wasted and payer requires reporting of discarded biological product.
`QK`	Monoclonal antibody administration — professional component	Use if payer requires reporting of specific administration components for biologic products (rare for Rho(D)).
`QX`	Authorization obtained — CRNA	Not commonly applicable to `90385`.
`QY`	Locum tenens – services furnished under arrangement	Use when a locum tenens practitioner furnished the service.
`TG`	Via a sterile processing/location specific modifier (varies by payer)	Use if payer-specific reporting for specialty distribution or handling is required.

Taxonomy Code	Specialty	Notes
`207V00000X`	Obstetrics & Gynecology	OB/GYN physicians commonly order and administer Rho(D) immune globulin in prenatal and postpartum settings.
`207L00000X`	Family Medicine	Family physicians provide prenatal care and may administer Rho(D) immune globulin in outpatient settings.
`208D00000X`	Hematology & Oncology	Hematologists may be involved when alloimmunization or complex antibody evaluation occurs.
`364S00000X`	Nurse Practitioner	Nurse practitioners in obstetrics or family practice frequently perform administration and documentation.
`163W00000X`	Clinical Nurse Specialist	Clinical nurses in maternal–fetal medicine or transfusion services often coordinate product handling and administration.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O36.0XX0`	Maternal care for rhesus isoimmunization, unspecified trimester, not applicable or unspecified	Used when monitoring and preventing maternal alloimmunization during pregnancy; indicates need for Rho(D) immune globulin.
`O36.0XX1`	Maternal care for rhesus isoimmunization, first trimester	Relevant when early pregnancy exposure requires assessment and possible Rho(D) prophylaxis.
`O36.0XX2`	Maternal care for rhesus isoimmunization, second trimester	Indicates ongoing antenatal management including consideration of Rho(D) immune globulin after sensitizing events.
`O36.0XX3`	Maternal care for rhesus isoimmunization, third trimester	Applied when planning intrapartum or immediate postpartum prophylaxis.
`Z21`	Asymptomatic human immunodeficiency virus [HIV] infection status	Included when special biologic handling or precautions are documented (use only if present clinically).
`Z31.42`	Encounter for pregnancy testing and childbirth education	Used in prenatal contexts where blood type and prophylaxis counseling occur.
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester	Common primary prenatal encounter where Rho(D) immune globulin may be administered as prophylaxis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (includes percutaneous, intramuscular, subcutaneous)	Used to report the act of intramuscular administration of an immunologic agent when payer requires separate reporting from the product `90385`.
`36415`	Collection of venous blood by venipuncture	Performed for blood typing, antibody screen, and compatibility testing prior to Rho(D) immune globulin administration.
`86900`	Crossmatch, recipient serum and donor red cells	Used when pretransfusion testing is required in cases with potential alloimmunization concerns.
`86355`	Antibody screen (e.g., indirect antiglobulin test)	Used to detect anti-D and other clinically significant antibodies before administering Rho(D) immune globulin.
`89050`	Gram stain; vaginal or cervical discharge (example for evaluating antepartum bleeding/infection)	Performed in evaluation of bleeding or infection when relevant to the clinical scenario (billing when performed).
`99070`	Supplies and materials provided by physician over and above those usually included with the office visit	Sometimes used when special supplies are required for preparation/administration of the biologic product.