Reimbursement Guidelines
RhoGAM® Ultra-Filtered PLUS/ MICRhoGAM® Ultra-Filtered PLUS
(Last Revised: July 2007)
This document is intended to provide general information about product, procedure and other codes used for RhoGAM® Brand and MICRhoGAM® Brand.
Codes Used in Physicians' Offices, Clinics and Outpatient Departments
|
Product |
Code |
Use |
|
Rho(D) immune globulin (Rhlg), human, full-dose, for intramuscular use |
90384 CPT® |
Private payers and some state
Medicaid programs1 |
|
J27902 |
Medicare and some state Medicaid1 |
|
Rho(D) immune globulin (Rhlg), human, mini-dose, for intramuscular use |
90385 CPT® |
Private payers and some state
Medicaid programs1 |
|
J27883 |
Medicare and some state Medicaid programs1 |
Current Procedural Terminology (CPT®) five-digit codes, descriptions, and other data only are copyright 2005 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®
Procedure Codes
|
Service |
Code |
Use |
|
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous
or intramuscular |
96372 CPT® |
Medicare (hospital outpatient
claims), state Medicaid programs
and private payers |
Inpatient Codes
ICD-9-CM Diagnosis Codes4
|
656 |
Other fetal and placental problems affecting management of mother |
|
656.1X |
Rhesus isoimmunization
Anti-D [Rh] antibodies
RH incompatibility |
5th Digit required: |
0-Unspecified as to the episode of care or not applicable
1-Delivered, with or without mention of antepartum condition
3-Antepartum condition or complication |
|
999.7 |
Rh incompatibility reaction |
|
99.11 |
Injection of Rh immune globulin |
Medicare Revenue Codes
The charge for the Rho D immune globuline drug should be listed on the HCFA-1450 (UB-92) under revenue code 0250 (General Classification Pharmacy) or 063X (Pharmacy-Drugs Requiring Detailed Coding) as required by the payer.
National Drug Codes (NDC)
| HCPCS Code (J2790, 90384) |
NDC 0562-7805-01
NDC 0562-7805-05 |
RhoGAM® Single Pack
RhoGAM® 5 Pack |
| |
NDC 0562-7805-25 |
RhoGAM® 25 Pack |
| HCPCS Code (J2788, 90385) |
NDC 0562-7806-01
NDC 0562-7806-05 |
MICRhoGAM® Single Pack
MICRhoGAM® 5 Pack |
| |
NDC 0562-7806-25 |
MICRhoGAM® 25 Pack |
NOTE The coding information in this document is derived from the CPT, ICD-9-CM and Healthcare Common Procedure Coding System (HCPCS) level II codebooks. The general rules and principles about using these coding sources, as described in this publication, will likely remain constant for years to come. However the actual numeric and alphanumeric codes themselves are subject to change with each subsequent annual revision of these sourcebooks. That is why it is important to have a new copy of this book and every coding book referenced each and every year.
DISCLAIMER The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Ortho-Clinical Diagnostics concerning levels of reimbursement, payment, or charges. Similarly, all CPT (Copyright AMA) and HCPCS codes are supplied for informational purposes only and represent no statement, promise, or guarantee by Ortho-Clinical Diagnostics that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payer. We strongly recommend that you consult your payer organization with regard to its reimbursement policies.
1 Always confirm coding requirements with payer prior to claims submission
2 Official descriptor for J2790-Injection, Rho(D) Immune globulin, human full dose, 300 mcg
3 Official descriptor for J2788-Injection, Rho(D) Immune globulin, human, minidose, 50 mcg
4 International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM)