CPT code 95130 is used to describe the immunotherapy treatment for a single sting insect allergy, helping healthcare providers document services accurately.
CPT code 95130 is used to describe the administration of an allergenic extract for immunotherapy involving a single sting insect. This code is specifically utilized when a healthcare provider administers an injection to a patient as part of a treatment plan to build immunity or reduce sensitivity to the venom of a particular insect, such as bees, wasps, or hornets. The goal of this immunotherapy is to help the patient's immune system become less reactive to the insect venom, thereby reducing the severity of allergic reactions in the event of future stings.
For CPT code 95130, which involves immunotherapy for a single sting insect, 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 procedure.
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 is used to identify procedures/services that are not normally reported together but are appropriate under the circumstances.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used when a procedure or service is repeated by another physician or qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. This modifier is used when it is necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results.
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.
CPT code 95130 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors, including the Medicare Physician Fee Schedule (MPFS) and the policies set by the Medicare Administrative Contractor (MAC) for your specific region.
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the final determination of whether CPT code 95130 is reimbursed can vary based on local coverage determinations (LCDs) and national coverage determinations (NCDs) established by the MAC.
It is essential for healthcare providers to verify with their regional MAC to understand the specific coverage criteria and reimbursement rates applicable to CPT code 95130.
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