CPT code 95132 is a medical code used to identify the treatment for immediate hypersensitivity reactions to insect stings.
CPT code 95132 is used to describe the preparation and provision of an allergenic extract for immunotherapy involving three different stinging insects. This code is typically utilized by healthcare providers, such as allergists or immunologists, who prepare and administer these specific allergenic extracts to patients as part of a treatment plan to reduce allergic reactions to insect stings. The code ensures that the provider is accurately reimbursed for the preparation of these customized extracts, which are tailored to the patient's specific allergy profile.
For CPT code 95132, which involves immunotherapy for three sting insects, 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 other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. This modifier is used for repeat laboratory tests performed on the same day to obtain subsequent (multiple) test results.
These modifiers help clarify the circumstances under which the CPT code 95132 is billed, ensuring accurate and appropriate reimbursement for the services provided. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 95132 is subject to reimbursement considerations under Medicare, but whether it is reimbursed depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the policies of the specific Medicare Administrative Contractor (MAC) overseeing the region where the service is provided.
The MPFS outlines the payment rates for services covered by Medicare, and each MAC has the authority to interpret and implement Medicare policies, which can affect the reimbursement status of specific CPT codes like 95132.
Therefore, healthcare providers should verify the reimbursement status of CPT code 95132 by consulting the MPFS and the relevant MAC guidelines to ensure compliance and proper billing practices.
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