What is CPT 95165?

The preparation of antigens for allergy shots, but not the injection itself, is billed under Current Procedural Terminology (CPT) code 95165, professional services for the provision of antigens for allergen immunotherapy; single or multiple antigens, per dose.

How often can you bill 95165?

Example: Use of code 95165 If a physician uses 1/2 cc doses from a 10cc multiple-dose vial for a total of 20 doses, they should bill for no more than 10 doses. If a physician prepares two 10cc multi-dose vials and uses 1/2cc from one vial, and 1cc from the other vial, they should bill for no more than 20 doses.

What is a LCD Medicare?

What’s a “Local Coverage Determination” (LCD)? LCDs are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MAC’s jurisdiction (region) in accordance with section 1862(a)(1)(A) of the Social Security Act.

Is 95165 covered by Medicare?

Effective January 1, 2001, for CPT code 95165, a dose is now defined as a one- (1) cc aliquot from a single multidose vial. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial.

What does the CPT code 95165 stand for?

Effective January 1, 2001, for CPT code 95165, a dose is now defined as a one- (1) cc aliquot from a single multidose vial. When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared.

What is Mue for 30 units of 95165?

Medicare Part B has medically unlikely edit (MUE) of any amount above 30 units to recognize that different vials of maintenance antigens can be made up for antigens that cannot be mixed together and must be kept separate. A patient who was given 30 units of 95165 received three shots.

When to use CPT code 95115 or 95117?

Use CPT procedure codes 95115/95117 and the appropriate CPT procedure code from the range 95145-95170 when reporting both the injection and the antigen/antigen preparation service (complete service). These instructions also apply to allergists who provide both services through the use of treatment boards. 5.

How to interpret CPT code 95004-95078?

Interpretation of CPT codes: 95004 – 95078; use the code number which includes the number of tests which were performed and enter 1 unit for each test performed. For example, if 18 scratch tests are done, code 95004 with 18 like services. If 36 are done, code 95004 with 36 like services.