CPT code 95078 is used for provocative testing to evaluate allergies, helping healthcare providers identify specific allergens affecting patients.
CPT code 95078 is used for provocative testing, which involves procedures designed to provoke a response in order to diagnose conditions such as allergies or asthma. This code is typically used when a healthcare provider administers a specific substance to a patient to observe and measure the body's reaction, helping to identify sensitivities or triggers. The results from this testing can guide treatment plans and management strategies for the patient's condition.
For CPT code 95078, which pertains to provocative testing, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service. This modifier is used when a significant, separately identifiable E/M service is performed in addition to the provocative testing.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the provocative testing is a distinct service from other procedures performed on the same day. It is used to prevent bundling of services that are typically considered part of a comprehensive service.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. This modifier is used when the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. This modifier is used when the same laboratory test is performed multiple times on the same day for the same patient to obtain subsequent (multiple) test results.
These modifiers should be applied based on the specific context of the service provided and the documentation supporting the need for the modifier. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
The CPT code 95078, which pertains to provocative testing, is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines.
The Medicare Physician Fee Schedule (MPFS) determines the payment rates for this code, and these rates can vary based on geographic location and other factors.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in processing claims and may have local coverage determinations (LCDs) that affect whether and how the code is reimbursed.
Providers should consult the MPFS and their respective MAC for detailed information on reimbursement rates and any specific requirements or limitations that may apply to CPT code 95078.
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