CPT code 95120 is used to identify the procedure for administering one injection of immunotherapy to patients.
CPT code 95120 is used to describe the administration of a single injection for allergen immunotherapy. This code is specifically utilized when a healthcare provider administers one injection containing allergenic extracts to a patient as part of a treatment plan designed to reduce or eliminate allergic reactions. Immunotherapy is a long-term treatment that aims to decrease sensitivity to allergens, and this particular code is applied when only one injection is given during a session.
For CPT code 95120, which pertains to immunotherapy with 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 if a significant, separately identifiable E/M service is performed in addition to 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.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used if the immunotherapy injection is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the immunotherapy injection is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although typically used for lab tests, if the immunotherapy injection is part of a series of tests, this modifier might be applicable to indicate a repeat test.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the immunotherapy service involves telemedicine components.
These modifiers help clarify the circumstances under which the immunotherapy injection is administered, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements, as these can vary.
CPT code 95120 is related to immunotherapy involving one injection. 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 95120 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service. However, the actual reimbursement can vary based on geographic location, as MACs have the authority to interpret national Medicare policies and establish local coverage determinations (LCDs).
To determine if CPT code 95120 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their MAC. This ensures compliance with Medicare's billing requirements and helps providers understand the specific conditions under which the service may be covered.
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