Accurate code reporting for allergy immunotherapy depends on understanding that physicians are to bill merely for the component codes, i.e., the injection-only CPT codes (95115 and 95117) and/or the codes representing antigens and their preparation (CPT 95144-95170). Physicians providing both services must bill for both in order to ensure accurate medical coding.
The CPT outlines immunotherapy (desensitization, hyposensitization) as the parenteral administration of allergenic extracts by means of antigens at periodic intervals, generally on an increasing dosage scale to a dosage which essentially is maintained as maintenance therapy. Understanding the dissimilarities between the following listed CPT codes is important to obtaining correct reimbursement for these codes:
CPT 95115-95117 (professional services for allergen immunotherapy excluding provision of allergenic extracts; single injection; as well as two or more injections,
CPT 95144 (professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single-dose vials [specify number of vials])
The office visit is a distinct procedure. The patient comes in originally for the office visit [99212-99215] along with scratch test. After that the serum is made [CPT 95144]. Then the patient visits the allergist again or takes the serum to their general practitioner and continues getting the shots though frequently they are required to get them [95115 or 95117).
How to Bill in Case an Outside Entity Creates the Antigen
Several allergists have the antigen created in a different place, for instance a pharmaceutical company. In these cases, the antigen preparation is taken as a part of the patients prescription program or patient's medication benefit. This is particularly true with managed care plans.
While you report 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) sometimes that will go to a dissimilar carrier. Blue Cross is infamous for that. You must find out which carrier the patients pharmacy program is with. The antigen is taken as a part of the prescription program, or patient's medication benefit. Remember that carriers will think through the antigen creation a preauthorized procedure. This implies that that you must be aware of your time limits for dosage administrations.
Also keep in mind that 95165 must be reported while you are using both 95115 (or 95117) and CPT 95144.
CPT 95144 (single dose vials of antigen) must be billed only in case the physician who makes the antigen is creating it to be injected by certain other entity.
While billing CPT 95144-95170, physicians must state the number of doses delivered in the units field. CPT Code 95165 signifies multiple-dose vials. A particular dose, in 95165, is the total amount of antigen to be administered to a patient during one treatment session. Physicians should specify the number of doses delivered in the full session.
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