CPT code 95117 is used to identify immunotherapy injections, which are treatments to help the body build immunity against specific allergens.
CPT code 95117 is used to describe the administration of two or more allergen immunotherapy injections. This code is typically utilized by healthcare providers when they administer multiple allergy shots during a single patient visit. It is important to note that this code does not include the preparation of the allergen extract itself, which is billed separately. Instead, CPT code 95117 specifically covers the professional service of administering the injections, ensuring that patients receive the appropriate dosage of allergens to help build their immunity over time.
For CPT code 95117, which pertains to immunotherapy injections, 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 a procedure or service was distinct or independent from other services performed on the same day. It may be applicable if multiple 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.
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. Although not typically used with immunotherapy injections, this modifier is used when a laboratory test is repeated for clinical reasons. It is included here for completeness in case of related diagnostic procedures.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to apply them correctly to avoid claim denials or delays.
CPT code 95117 is reimbursed by Medicare, but the reimbursement is subject to several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered under Medicare Part B, including immunotherapy injections. To determine the specific reimbursement rate for CPT code 95117, healthcare providers should refer to the MPFS, which outlines the allowable charges for each service.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and may have specific local coverage determinations (LCDs) that affect the reimbursement of certain CPT codes, including 95117. Therefore, it is essential for healthcare providers to consult their respective MACs to understand any regional variations or additional documentation requirements that may impact the reimbursement of CPT code 95117.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments down to the CPT code level, including specific codes like 95117. Schedule a demo today to see how RevFind can pinpoint discrepancies with individual payers and ensure you receive the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
