CPT code 95145 is a code used to identify antigen therapy services provided to patients for allergy treatment and management.
CPT code 95145 is used to describe the preparation and provision of antigen therapy services. This code specifically pertains to the preparation of a single dose vial of antigen for allergen immunotherapy. It involves the process of creating a customized mixture of allergens that are tailored to a patient's specific allergy profile. This service is typically part of a broader allergy treatment plan aimed at desensitizing patients to specific allergens, thereby reducing allergic reactions over time. The code is utilized by healthcare providers to accurately document and bill for the preparation of these antigen therapies.
For CPT code 95145, which pertains to antigen therapy services, 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 E/M service is performed in conjunction with 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 billed separately.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used when the same procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for antigen therapy, if a diagnostic test related to the therapy is repeated, this modifier may be applicable.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. If the antigen therapy service involves telemedicine, this modifier may be used.
These modifiers help ensure accurate billing and reimbursement by providing additional context about the services rendered. It's important to review payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 95145 is related to 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 guidelines set forth by the Medicare Administrative Contractor (MAC) 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 95145 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to the conditions and limitations outlined in the schedule.
Additionally, MACs, which are private organizations contracted by Medicare, play a crucial role in determining coverage and reimbursement for specific services. They interpret national policies and create local coverage determinations (LCDs) that can affect whether a particular CPT code, such as 95145, is reimbursed in their jurisdiction.
Therefore, to determine if CPT code 95145 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs issued by their regional MAC. This will provide the most accurate and up-to-date information regarding Medicare reimbursement for this specific code.
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