CPT code 95144 is a code used to identify antigen therapy services provided to patients for allergy treatment and management.
CPT code 95144 is used to describe the preparation and provision of antigen therapy services. Specifically, this code refers to the preparation of a single dose vial of antigen used for immunotherapy. Immunotherapy is a treatment designed to enhance or suppress the immune system's response to various allergens. This code is typically utilized by healthcare providers who prepare and administer these antigen doses to patients as part of allergy treatment plans. The code helps in billing and tracking the specific service of preparing the antigen for therapeutic use.
For CPT code 95144, which pertains to antigen therapy services, the following modifiers may be applicable depending on the specific circumstances of the service provided:
1. Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. This modifier is used when a significant, separately identifiable E/M service is performed by the same provider on the same day as the antigen therapy.
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 antigen therapy services are provided 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 not typically used for antigen therapy, if the service involves repeated laboratory testing, this modifier may be applicable to indicate that the test was repeated for a valid medical reason.
These modifiers help clarify the context and specifics of the services provided, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 95144 is associated with antigen therapy services. Whether this code is reimbursed by Medicare depends on several factors, including its inclusion in the Medicare Physician Fee Schedule (MPFS) and the specific policies of the Medicare Administrative Contractor (MAC) that processes claims in your region.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 95144 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to any applicable coverage policies.
However, the final determination of reimbursement also involves the MAC, which is responsible for processing Medicare claims and may have specific local coverage determinations (LCDs) that affect whether a particular service is covered. These LCDs can vary by region and may impose additional requirements or limitations on the reimbursement of certain CPT codes.
Therefore, to ascertain if CPT code 95144 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their MAC. This will provide the most accurate and up-to-date information regarding the reimbursement status of this code.
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