CPT code 95024 is a specific code used to identify an allergy test for drugs or insects, helping healthcare providers document and categorize services.
CPT code 95024 is used to describe an "Icut allergy test drug/bug," which refers to a specific type of allergy testing procedure. This procedure involves introducing a small amount of an allergen, such as a drug or insect venom, into the skin using a superficial scratch or prick. The purpose of this test is to observe the skin's reaction to the allergen, which helps healthcare providers determine if a patient has an allergic sensitivity to the substance being tested. This code is commonly used in allergy clinics and practices to document and bill for the administration of these skin tests.
For CPT code 95024, which pertains to cutaneous allergy testing, 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 an E/M service is provided on the same day as the allergy testing, indicating that the E/M service is distinct and separate from the testing.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the allergy testing is distinct or independent from other services performed on the same day. It helps to avoid bundling issues and ensures that the testing is recognized as a separate service.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used if the same allergy test is repeated on the same day by the same provider, indicating that the repeat test was necessary.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same allergy test is repeated on the same day by a different provider, indicating the necessity of the repeat test by another professional.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although primarily used for laboratory tests, this modifier can be applicable if the allergy test needs to be repeated for clinical reasons, ensuring that the repeat test is not considered a duplicate.
These modifiers help clarify the context and necessity of the services provided, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary between insurance carriers.
CPT code 95024, which involves an allergy test, is reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary. The reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
However, it's important to note that the final decision on reimbursement can also be influenced by the local policies of the Medicare Administrative Contractor (MAC) that processes claims in a specific region. Each MAC may have specific guidelines or requirements that must be met for the service to be reimbursed, so healthcare providers should verify with their local MAC to ensure compliance with any additional criteria.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With the ability to read your contracts and detect underpayments down to the CPT code level, including specific codes like 95024, RevFind provides unparalleled accuracy and insight. Schedule a demo today to see how RevFind can help you identify discrepancies by individual payer and optimize your revenue cycle management.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
