CPT code 95146 is a code used to describe antigen therapy services, which involve the administration of specific allergens for treatment.
CPT code 95146 is used to describe antigen therapy services, specifically for the preparation and provision of antigens for immunotherapy. This code is applicable when a healthcare provider prepares a single dose vial of antigens that contains a mixture of multiple antigens. The code is utilized in billing to ensure that the healthcare provider is reimbursed for the time and resources spent in preparing the antigen mixture for a patient's allergy treatment. It is important for accurate documentation and billing to ensure compliance and proper reimbursement in the revenue cycle management process.
For CPT code 95146, 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 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 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 is used when the antigen therapy is performed in conjunction with other procedures that are not typically reported together.
3. Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional. This modifier is used when the antigen therapy service 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 antigen therapy service is repeated by a different provider on the same day.
5. Modifier 91: Repeat Clinical Diagnostic Laboratory Test. Although less common for antigen therapy, this modifier may be used if the antigen therapy involves repeated testing for clinical diagnostic purposes.
6. Modifier 52: Reduced Services. This modifier is used when the antigen therapy service is partially reduced or eliminated at the discretion of the physician or other qualified healthcare professional.
7. Modifier 53: Discontinued Procedure. This modifier is used when the antigen therapy service is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
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.
The CPT code 95146 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines. The Medicare Physician Fee Schedule (MPFS) outlines the payment rates for services covered under Medicare Part B, including those associated with CPT code 95146. However, the actual reimbursement can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national Medicare policies and establish local coverage determinations (LCDs) that may affect the reimbursement of this code. Therefore, healthcare providers should consult their respective MAC for detailed information on coverage and reimbursement specifics for CPT code 95146.
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