CPT code 95071 is used to identify bronchial allergy tests, helping healthcare providers document and categorize these specific allergy evaluations.
CPT code 95071 is used to describe bronchial allergy tests. This code is specifically applied when a healthcare provider conducts tests to identify allergic reactions in the bronchial tubes, which are part of the respiratory system. These tests are typically performed to diagnose conditions such as asthma or other respiratory allergies by exposing the patient to specific allergens and observing the bronchial response. The results help in tailoring appropriate treatment plans for managing allergic conditions effectively.
For CPT code 95071, which pertains to bronchial allergy tests, the following modifiers may be applicable:
1. Modifier 25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional 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 provider on the same day as the bronchial 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 applicable if multiple tests or procedures are performed that are not typically reported together.
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 on the same day. It may be relevant if the bronchial 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 on the same day.
5. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a clinical diagnostic laboratory test is repeated on the same day to obtain subsequent test results. It may be applicable if the bronchial allergy test is considered a laboratory test and needs to be repeated.
These modifiers help clarify the circumstances under which the bronchial allergy test is performed and ensure accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific policies to ensure correct usage.
CPT code 95071 is associated with bronchial allergy tests. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific guidelines set by the Medicare Administrative Contractor (MAC) for the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 95071 is listed on the MPFS, it indicates that Medicare may provide reimbursement for this service, subject to coverage policies and medical necessity.
However, it's important to note that each MAC, which administers Medicare claims for specific geographic areas, may have additional local coverage determinations (LCDs) that affect reimbursement. These LCDs can specify conditions under which the service is covered or any documentation requirements that must be met.
Healthcare providers should verify the inclusion of CPT code 95071 in the MPFS and consult their regional MAC's guidelines to determine the specific reimbursement criteria and ensure compliance with Medicare's billing requirements.
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