CPT code 95149 is for antigen therapy services, which involve the administration of specific allergens to help manage allergic reactions.
CPT code 95149 is used to describe antigen therapy services, specifically for the preparation and provision of a single dose vial of antigen. This code is typically utilized in the context of allergy immunotherapy, where a healthcare provider prepares a specific antigen extract tailored to a patient's allergy profile. The code covers the professional services involved in creating the antigen mixture, ensuring it is ready for administration to the patient as part of their allergy treatment plan.
For CPT code 95149, 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 an additional E/M service is provided 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 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 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 less common for antigen therapy, this modifier is used when a laboratory test is repeated on the same day to obtain subsequent results.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is applicable if the antigen therapy service is provided through telemedicine.
These modifiers help ensure accurate billing and reimbursement by providing additional context to the services rendered. It's important to verify payer-specific guidelines as they may have unique requirements for the use of modifiers.
CPT code 95149 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 guidelines set forth by the Medicare Administrative Contractor (MAC) for your region.
To determine if CPT code 95149 is reimbursed by Medicare, you would first need to consult the MPFS, which outlines the payment rates and coverage policies for services provided to Medicare beneficiaries. The MPFS is updated annually and provides a comprehensive list of CPT codes that are reimbursable under Medicare, along with their respective payment amounts.
Additionally, each MAC, which is responsible for processing Medicare claims in specific geographic areas, may have its own local coverage determinations (LCDs) that affect reimbursement. These LCDs can provide further guidance on whether a particular service, such as one billed under CPT code 95149, is covered and under what circumstances.
Therefore, to confirm the reimbursement status of CPT code 95149, healthcare providers should review the latest MPFS and consult with their regional MAC for any specific coverage policies or requirements.
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