CPT code 95165 is for antigen therapy services, which involve the preparation and administration of allergy immunotherapy.
CPT code 95165 is used for antigen therapy services, specifically for the preparation and provision of antigens for allergen immunotherapy. This code is typically utilized by healthcare providers who prepare and supply allergenic extracts for patients undergoing allergy treatments. The code covers the preparation of a single dose vial of antigen, which is used in the process of desensitizing patients to specific allergens. This service is crucial for patients with allergic conditions, as it helps in reducing their sensitivity to allergens over time, thereby improving their quality of life.
For CPT code 95165, 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 E/M 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 that are not typically performed together.
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 with antigen therapy, if the service involves repeated testing, this modifier may be applicable to indicate that the test was repeated for a valid medical reason.
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 through telemedicine.
These modifiers help clarify the circumstances under which the antigen therapy services were provided, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines, as modifier usage can vary.
CPT code 95165 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 the region where the service is provided.
The MPFS is a comprehensive listing of fees used by Medicare to reimburse physicians and other healthcare providers for services rendered. If CPT code 95165 is listed in the MPFS, it indicates that Medicare recognizes the service for reimbursement, subject to the conditions and limitations outlined in the schedule.
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 further define the circumstances under which CPT code 95165 is reimbursable. Providers should consult the relevant MAC's policies to ensure compliance with any additional requirements or documentation needed for reimbursement.
In summary, while CPT code 95165 may be reimbursed by Medicare if it is included in the MPFS, healthcare providers must also adhere to the specific guidelines and coverage determinations set by their local MAC to ensure successful reimbursement.
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