2025 CPT code 90396
(Active) Effective Date: N/A Revision Date: N/A Medicine - Immune Globulins, Serum or Recombinant Products Medicine Services and Procedures Feed
Supply of human varicella-zoster immune globulin (VZIG) for intramuscular use.
Modifier 51 is not applicable with this code. Other modifiers may be applicable based on the circumstances of the administration.
VZIG is medically necessary for high-risk individuals exposed to varicella-zoster virus or for those with a compromised immune system to prevent or reduce the severity of the infection. Medical necessity is determined based on individual patient characteristics and clinical assessment.
The physician is responsible for ordering and overseeing the administration of the VZIG.Nursing staff or other qualified personnel may perform the injection.
In simple words: This code covers the cost of the medicine varicella-zoster immune globulin (VZIG), given as a shot to prevent or reduce the severity of chickenpox in people at high risk.The actual shot itself is billed separately.
This CPT code reports the supply of human varicella-zoster immune globulin (VZIG) for intramuscular administration. VZIG is a solution of antibodies derived from pooled human plasma, containing a high titer of antibodies against the varicella-zoster virus (human herpesvirus 3).It's used to prevent or lessen the severity of chickenpox in high-risk individuals. Note that administration (intramuscular injection) is coded separately using codes from the 96365-96375 range, with the specific substance identified. Modifier 51 should not be used with this code if another procedure is performed.
Example 1: A pregnant woman with no immunity to chickenpox is exposed to the virus.VZIG is administered to prevent infection., A newborn with a compromised immune system is given VZIG as a prophylactic measure to prevent chickenpox., A child with leukemia, who is immunocompromised and exposed to the chickenpox virus, receives VZIG to reduce the severity of potential infection.
* Documentation should include the patient's medical history, reason for VZIG administration (e.g., exposure to varicella, immunocompromised status), and confirmation of the product's administration.*Documentation of the specific product administered (90396) and administration code used (96365-96375) is required.
** Always refer to the most current CPT manual and payer-specific guidelines for accurate coding and reimbursement.
- Revenue Code: P6D (Minor Procedures - Other)
- RVU: Refer to the AMA CPT website and your specific payer's fee schedule for RVU and payment information.RVUs vary based on location, payer, and other factors.
- Global Days: Not applicable; this code represents the supply of the medication, not a procedure with a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable; this code is for the supply of the medication, not the technical component of a procedure.
- Fee Schedule: Refer to historical CPT fee schedules or your payer's records for prior pricing information.
- Specialties:Infectious Disease, Pediatrics, Immunology, Obstetrics and Gynecology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Clinic