CPT code 95134 is a medical code used to describe the immunotherapy treatment for allergies to five types of stinging insects.
CPT code 95134 is used to describe the administration of an immunotherapy treatment involving five different stinging insect venoms. This code is typically utilized by healthcare providers when billing for the preparation and provision of allergy immunotherapy, specifically for patients who require desensitization to the venom of five distinct stinging insects. This treatment is often necessary for individuals who have demonstrated allergic reactions to insect stings and need to build up their immunity to prevent severe allergic responses in the future.
For CPT code 95134, which involves immunotherapy for five 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 an additional E/M service is provided on the same day as the immunotherapy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the immunotherapy 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 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 is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although less common for immunotherapy, this modifier could be used if the procedure involves repeated testing for the same patient on the same day.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is applicable if the immunotherapy service is provided through telemedicine.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the service provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 95134 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 list of fees that Medicare uses to reimburse physicians and other healthcare providers for services rendered. However, whether CPT code 95134 is reimbursed can also depend on local coverage determinations (LCDs) made by the MAC, which may vary based on geographic location and specific medical necessity criteria.
It is essential for healthcare providers to verify the reimbursement status of CPT code 95134 with their respective MAC to ensure compliance and proper billing practices.
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