CPT code 95115 is a code used to identify the administration of one injection for immunotherapy treatments.
CPT code 95115 is used to describe the administration of a single injection for allergen immunotherapy. This code is specifically utilized when a healthcare provider administers an injection containing allergens to a patient as part of a treatment plan aimed at reducing allergic reactions. It is important to note that this code covers only the administration of the injection itself and does not include the cost of the allergenic extract or any additional services. This code is typically used in allergy clinics or practices where patients receive regular immunotherapy injections to build up their tolerance to specific allergens over time.
For CPT code 95115, which pertains to immunotherapy involving one injection, 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 immunotherapy injection.
2. Modifier 59: Distinct Procedural Service. This modifier is used to indicate that the immunotherapy injection is distinct or independent from other services performed on the same day. It is typically used to prevent bundling of services that are usually considered part of a single procedure.
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 on the same day by the same provider, indicating that the service was necessary and not a duplicate billing error.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when the same procedure is repeated on the same day by a different provider, indicating that the service was necessary and not a duplicate billing error.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although not typically used with immunotherapy injections, this modifier is applicable if the injection is part of a diagnostic test that needs to be repeated for clinical reasons.
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 95115 is reimbursed by Medicare, but the 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 associated payment rates. However, the reimbursement for CPT code 95115 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and apply them to local circumstances, which can affect the reimbursement rates and coverage criteria for this specific CPT code. Therefore, healthcare providers should consult their local MAC for precise information regarding the reimbursement of CPT code 95115 in their area.
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