Summary & Overview
CPT 90396: Intramuscular Varicella–Zoster Immune Globulin Supply
CPT code 90396 designates the supply of intramuscular human varicella–zoster immune globulin for prevention or augmentation of immunity against chickenpox. This code captures a specific biologic prophylactic product used in clinical circumstances where passive immunization is indicated. Nationally, accurate reporting of this code matters for tracking use of immune globulins, ensuring appropriate coverage, and aligning billing with clinical guidelines for post-exposure or pre-exposure prophylaxis.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical context for 90396, typical sites of service, and the service type. The analysis covers payer coverage patterns and coding benchmarks where available, notes common billing modifiers used with this service, and highlights policy considerations relevant to reimbursement and documentation. Where payers have specific coverage rules or prior authorization requirements, those will be summarized to clarify administrative expectations.
This national-level summary is intended for billing staff, clinicians, and policy analysts who require a clear, practical reference for coding and documenting intramuscular varicella–zoster immune globulin supply and administration under CPT code 90396.
Billing Code Overview
CPT code 90396 reports the supply of intramuscular human varicella–zoster immune globulin used to prevent or boost immunity against chickenpox. This service involves administration of a prepared immune globulin product intended for prophylaxis or passive immunization in eligible individuals.
Service type: Immune globulin supply and administration
Typical site of service: Outpatient clinic, physician office, or infusion clinic
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A typical patient is an immunocompromised adult or newborn with recent exposure to varicella (chickenpox) or a high-risk pregnant woman without evidence of varicella immunity. The patient presents to an outpatient infusion or immunization clinic, emergency department, or inpatient unit for evaluation of exposure and suitability for prophylaxis. The clinician documents the exposure history, immune status (history of varicella, vaccination records, or varicella IgG serology), and risk factors (e.g., hematologic malignancy, solid organ transplant, immunosuppressive therapy, pregnancy, neonate of a mother with peripartum varicella). When indicated, intramuscular human varicella–zoster immune globulin is ordered and administered as a single IM dose. The workflow includes informed consent, verification of product lot and expiration, medication preparation by pharmacy or trained nursing staff, administration with standard IM technique, and documentation of lot number, dose, site, and patient response. Billing uses 90396 for the supply of the immune globulin; the medical record links the administration to the qualifying exposure and relevant diagnosis code(s). Typical sites of service include outpatient clinics, emergency departments, hospital inpatient units, and specialty infusion centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no special circumstances apply and the service is billed normally |