CPT code 95131 is a medical code used to identify the immunotherapy treatment for two insect stings, facilitating accurate documentation and reimbursement.
CPT code 95131 is used to describe the preparation and provision of an immunotherapy treatment involving two different stinging insect venoms. This code is typically utilized by healthcare providers when billing for the administration of allergy shots designed to desensitize patients to the venom of specific stinging insects, such as bees or wasps. The code indicates that the treatment involves two distinct insect venoms, which are prepared and administered as part of a therapeutic regimen to reduce allergic reactions in patients with insect venom allergies.
For CPT code 95131, which involves immunotherapy with two sting insect venoms, 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 may be necessary if multiple procedures are performed and need to be distinguished from one another.
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 less common for immunotherapy, this modifier is used when a laboratory test is repeated on the same day to obtain subsequent results.
These modifiers help ensure accurate billing and reimbursement by providing additional context for the services rendered. It's important to use them appropriately to avoid claim denials or delays.
CPT code 95131 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 of the local Medicare Administrative Contractor (MAC).
The MPFS provides a comprehensive listing of fees used to reimburse physicians and other healthcare providers on a fee-for-service basis. However, the actual reimbursement for CPT code 95131 may vary depending on the specific guidelines and coverage determinations set forth by the MAC in your region.
It is essential for healthcare providers to verify with their local MAC to ensure that CPT code 95131 is covered and to understand any specific billing requirements or limitations that may apply.
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