CPT code 95027 is a medical code used to identify and document allergy testing for airborne allergens in patients.
CPT code 95027 is used to describe a procedure involving the titration of allergy tests specifically for airborne allergens. This code is applicable when a healthcare provider conducts a series of tests to determine the specific concentration of allergens that trigger an allergic reaction in a patient. The process involves gradually increasing the amount of the allergen to identify the threshold at which the patient begins to react. This information is crucial for developing a personalized allergy management plan, including immunotherapy or avoidance strategies.
For CPT code 95027, which involves 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 if an E/M service is provided on the same day as the allergy testing and is distinct from the testing itself.
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 prevent bundling of services that are not typically reported together.
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 testing 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 allergy testing is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when the allergy test is repeated for clinical reasons on the same day to obtain subsequent results.
These modifiers help ensure accurate billing and reimbursement by clarifying the nature of the services provided. Always verify payer-specific guidelines, as modifier requirements can vary.
The CPT code 95027 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors. The Medicare Physician Fee Schedule (MPFS) is a critical resource for determining if a specific CPT code is reimbursed by Medicare. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals.
For CPT code 95027, you would need to consult the MPFS to verify if it is listed and what the reimbursement rate might be. Additionally, Medicare Administrative Contractors (MACs) play a significant role in determining coverage and reimbursement for specific services. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that can affect whether a particular service is reimbursed in their jurisdiction.
Therefore, to ascertain if CPT code 95027 is reimbursed by Medicare, healthcare providers should review the MPFS for the current year and consult with their respective MAC to understand any local policies or requirements that might impact reimbursement.
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