CPT code 95004 is used for percutaneous allergy skin tests, which help identify allergic reactions to specific substances.
CPT code 95004 is used to describe percutaneous allergy skin tests. This code is specifically for tests that involve introducing potential allergens into the skin through a prick or puncture method to observe any allergic reactions. These tests are commonly performed to identify specific allergens that may cause allergic reactions in patients, such as pollen, mold, pet dander, or certain foods. The results help healthcare providers develop appropriate treatment plans or avoidance strategies for managing allergies.
For CPT code 95004, which pertains to percutaneous allergy skin tests, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is a list of potential modifiers that could be used:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. This modifier is used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the allergy skin test.
2. Modifier 59: Distinct Procedural Service. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple allergy tests are performed and need to be distinguished from one another.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated on the same day by the same provider, which might occur if additional testing is required.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated on the same day by a different provider, which might be relevant in a multi-provider practice setting.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. While typically used for laboratory tests, this modifier might be applicable if the allergy skin test is repeated for clinical reasons on the same day.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines provided by the American Medical Association and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 95004 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service. However, the actual reimbursement for CPT code 95004 can vary based on geographic location and other factors determined by the Medicare Administrative Contractor (MAC) responsible for processing claims in a particular region. Each MAC may have specific local coverage determinations (LCDs) that further define the circumstances under which CPT code 95004 is reimbursable. Therefore, healthcare providers should consult the MPFS and their respective MAC's guidelines to ensure compliance and accurate billing for this service.
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