CPT code 95147 is a code used to identify antigen therapy services provided to patients for allergy treatment and management.
CPT code 95147 is used to describe professional services related to the preparation and provision of antigen therapy, specifically for allergen immunotherapy. This code is applicable when a healthcare provider prepares a single dose vial of antigen for a patient, which is then used in the treatment of allergies through immunotherapy. The code covers the professional service aspect of creating the antigen mixture tailored to the patient's specific allergy profile, ensuring that the therapy is customized for effective treatment.
For CPT code 95147, 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 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 less common for antigen therapy, this modifier may be used if the antigen therapy involves repeated testing on the same day for clinical reasons.
6. Modifier 95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. This modifier is used if the antigen therapy service is provided via telemedicine.
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 policies to ensure accurate billing and reimbursement.
CPT code 95147 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) for 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 95147 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to compliance with coverage criteria and documentation requirements.
However, the final determination of reimbursement can also be influenced by the local MAC, which administers Medicare claims and provides guidance on coverage policies. Each MAC may have specific local coverage determinations (LCDs) that outline the conditions under which a service is covered. Therefore, it is crucial to consult the relevant MAC's policies to ensure that CPT code 95147 is reimbursable in your specific jurisdiction.
In summary, while CPT code 95147 may be reimbursed by Medicare if it is included in the MPFS, healthcare providers should verify with their local MAC to confirm coverage and any additional requirements that may apply.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments at the CPT code level, including specific codes like 95147. Schedule a demo today to see how RevFind can help you maximize reimbursements from each payer and ensure you're receiving the full compensation you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
