CPT code 95170 is for antigen therapy services, which involve the administration of specific allergens to help manage allergic reactions.
CPT code 95170 is used to describe the preparation and provision of antigen therapy services. This code is specifically for the preparation of a single dose vial of antigen for allergen immunotherapy. It involves the mixing of antigens that are used to treat allergies by gradually desensitizing the patient's immune system to specific allergens. This code is typically utilized by healthcare providers who administer allergy shots or other forms of immunotherapy to help manage and reduce allergic reactions in patients.
For CPT code 95170, 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.
2. Modifier 59: Distinct Procedural Service. This modifier is applied to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used when antigen therapy is 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 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 applicable when the antigen therapy service 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.
These modifiers help clarify the circumstances under which the antigen therapy services are provided, ensuring accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.
CPT code 95170 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 95170 is listed in the MPFS, it indicates that Medicare has established a reimbursement rate for this service, subject to any applicable coverage policies.
However, the final determination of reimbursement also depends on the MAC, which is responsible for processing Medicare claims and providing guidance on coverage policies in specific geographic areas. Each MAC may have unique local coverage determinations (LCDs) that affect whether and how a particular service, such as one billed under CPT code 95170, is reimbursed.
Therefore, to confirm if CPT code 95170 is reimbursed by Medicare, healthcare providers should consult the MPFS for the current year and review any relevant LCDs or guidance from their regional MAC. This ensures compliance with Medicare's billing and reimbursement policies.
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