CPT code 95148 is for antigen therapy services, which involves the administration of allergy immunotherapy to patients.
CPT code 95148 is used to describe antigen therapy services, specifically for the preparation and provision of single-dose vials of allergenic extracts. This code is applicable when a healthcare provider prepares and supplies a single dose of an allergen extract for a patient, typically as part of an allergy immunotherapy treatment plan. The code ensures that the provider is reimbursed for the time and resources involved in preparing these individualized treatment doses.
For CPT code 95148, 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 evaluation and management service is performed by the same physician on the same day as the antigen therapy service.
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 applicable when antigen therapy services are provided 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 not commonly used with antigen therapy, this modifier may be applicable if the service involves repeated laboratory testing on the same day for the same patient.
These modifiers help clarify the circumstances under which the antigen therapy services are provided, ensuring accurate billing and reimbursement. It is important to review payer-specific guidelines as they may have additional requirements or restrictions regarding the use of these modifiers.
The CPT code 95148 is reimbursed by Medicare, but it is essential to verify its status under the Medicare Physician Fee Schedule (MPFS) and with your specific Medicare Administrative Contractor (MAC). The MPFS provides a comprehensive list of services covered by Medicare, including their reimbursement rates, which can vary based on geographic location and other factors.
Additionally, MACs are responsible for processing Medicare claims and can offer guidance on coverage specifics, including any local coverage determinations (LCDs) that might affect reimbursement for CPT code 95148. Therefore, healthcare providers should consult both the MPFS and their MAC to ensure accurate billing and reimbursement for this service.
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