CPT code 95076 is used for an ingest challenge test that lasts 120 minutes, helping healthcare providers document specific patient evaluations.
CPT code 95076 is used to describe an ingestion challenge test that is conducted over a period of 120 minutes. This procedure involves administering a specific substance orally to a patient to monitor and evaluate their reaction over the designated time frame. The test is typically used to identify allergic reactions or sensitivities to certain foods or medications. The 120-minute duration allows healthcare providers to observe any immediate or delayed responses, ensuring a comprehensive assessment of the patient's tolerance to the ingested substance.
For CPT code 95076, which involves an ingestion challenge lasting up to 120 minutes, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required. If the ingestion challenge requires significantly more effort or time than usual, this modifier may be appropriate.
2. Modifier 52 - Reduced Services: If the ingestion challenge is partially completed or less than the typical service is provided, this modifier can be used to indicate that the service was reduced.
3. Modifier 76 - Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: This modifier is applicable if the ingestion challenge needs to be repeated on the same day by the same provider.
4. Modifier 77 - Repeat Procedure by Another Physician or Other Qualified Health Care Professional: Use this modifier if the ingestion challenge is repeated on the same day by a different provider.
5. 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 the ingestion challenge is performed in conjunction with other procedures that are not typically reported together.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although less common for this specific code, if the ingestion challenge is part of a series of tests that need to be repeated for clinical reasons, this modifier may be applicable.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
The CPT code 95076 is reimbursed by Medicare, but its reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the payment rates for each service.
However, the actual reimbursement for CPT code 95076 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and making coverage determinations within their jurisdiction, so it is important for healthcare providers to consult their specific MAC for detailed information regarding reimbursement for CPT code 95076.
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