CPT code 95017 is a specific code used to identify and report allergy testing for venom exposure in healthcare settings.
CPT code 95017 is used to describe a percutaneous (through the skin) and intracutaneous (within the skin) allergy test specifically for venoms. This code is utilized when healthcare providers perform allergy testing to determine a patient's sensitivity to various venom allergens, such as those from bees, wasps, or other stinging insects. The procedure involves introducing small amounts of venom allergens into the skin to observe any allergic reactions, which helps in diagnosing venom allergies and planning appropriate treatment or desensitization therapies.
For CPT code 95017, which involves percutaneous and intradermal allergy testing with venoms, the following modifiers may be applicable:
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 testing.
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 billed separately.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. This modifier is used when a laboratory test is repeated on the same day to obtain subsequent (multiple) test results.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It is important to use them appropriately to avoid claim denials or delays.
CPT code 95017 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) that processes claims in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers on a fee-for-service basis. If CPT code 95017 is listed on the MPFS, it indicates that Medicare has established a payment rate for this service, subject to any applicable coverage policies.
However, even if a CPT code is included in the MPFS, reimbursement is not guaranteed. Each MAC, which is responsible for processing Medicare claims in specific geographic areas, may have additional local coverage determinations (LCDs) that affect whether a particular service is reimbursed. These LCDs can vary between MACs, meaning that CPT code 95017 might be reimbursed in one region but not in another, depending on the MAC's policies.
To determine if CPT code 95017 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their MAC. This ensures that they have the most accurate and up-to-date information regarding Medicare reimbursement for this specific code.
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