CPT code 95028 is a specific code used to identify a delayed allergy test for skin reactions to allergens.
CPT code 95028 is used to describe an intradermal (under the skin) allergy test that is specifically designed to identify delayed allergic reactions. This type of test involves introducing a small amount of an allergen into the skin and observing the area over a period of time to see if a delayed reaction occurs, which can help in diagnosing allergies that do not manifest immediately. This code is typically used by healthcare providers to document and bill for the procedure when assessing a patient's allergic sensitivities.
For CPT code 95028, which pertains to cutaneous allergy testing for delayed reactions, 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 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 by the same provider. It may apply if the allergy test needs to be repeated for any reason.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: This modifier is used when the same procedure is repeated by a different provider. It may be applicable if the patient is seen by another healthcare professional for the same test.
5. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the test is repeated for clinical reasons, such as verifying 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 95028, which refers to an icut allergy test-delayed, is subject to reimbursement by Medicare, but this is contingent upon several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in determining whether a specific CPT code is reimbursable. The MPFS outlines the payment rates for services provided by physicians and other healthcare professionals, including allergy testing.
However, the reimbursement for CPT code 95028 is not solely determined by the MPFS. Medicare Administrative Contractors (MACs) are responsible for processing claims and have the authority to make coverage decisions based on local coverage determinations (LCDs). These LCDs can vary by region, meaning that the reimbursement for this code may differ depending on the MAC jurisdiction.
Healthcare providers should verify the specific coverage policies and reimbursement rates for CPT code 95028 with their respective MAC to ensure compliance and accurate billing. Additionally, it is essential to confirm that the service meets the medical necessity criteria established by Medicare to qualify for reimbursement.
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