CPT code 95133 is a medical code used to identify the treatment for immediate allergy desensitization to four insect stings.
CPT code 95133 is used to describe the preparation and provision of an allergenic extract for immunotherapy involving four different stinging insects. This code is typically utilized by healthcare providers who are administering allergy shots to patients with sensitivities to insect stings, such as those from bees, wasps, hornets, or yellow jackets. The code indicates that the immunotherapy treatment involves a combination of extracts from four distinct insect species, tailored to the patient's specific allergic profile. This service is part of a broader allergy management plan aimed at reducing the patient's allergic reactions to these insect stings over time.
For CPT code 95133, which involves immunotherapy for four 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 if a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as the immunotherapy.
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 reported separately.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used if the same procedure is repeated by the same provider, which may occur in cases where additional doses or treatments are administered.
4. Modifier 77: Repeat Procedure by Another Physician or Other Qualified Health Care Professional. This modifier is used if the procedure is repeated by a different provider, which might be relevant in a multi-provider practice setting.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although less common for immunotherapy, this modifier might be used if the procedure involves repeated testing as part of the treatment protocol.
6. Modifier 22: Increased Procedural Services. This modifier is used when the work required to provide a service is substantially greater than typically required. It may apply if the immunotherapy involves additional complexity or time.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association and payer-specific policies to ensure accurate billing and reimbursement.
CPT code 95133 is subject to reimbursement by Medicare, but whether it is reimbursed 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 outlines the payment rates for services covered by Medicare, and each MAC may have additional local coverage determinations that influence reimbursement.
Therefore, healthcare providers should verify the reimbursement status of CPT code 95133 by consulting the MPFS and the relevant MAC's policies to ensure compliance and proper billing practices.
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