CPT code 95180 is used to describe the process of rapid desensitization for patients with allergies, helping them tolerate allergens more effectively.
CPT code 95180 is used to describe the procedure of rapid desensitization. This process involves administering increasing doses of an allergen to a patient over a short period to build up their tolerance to the allergen. It is typically used in situations where a patient needs to be desensitized quickly, such as when they have a severe allergy to a medication that is necessary for their treatment. The procedure is carefully monitored by healthcare professionals to ensure patient safety and effectiveness.
For CPT code 95180, "Rapid desensitization," 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 or other qualified healthcare professional on the same day of the procedure or other service. Use this modifier if an E/M service was provided on the same day as the rapid desensitization procedure and is distinct from the procedure itself.
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 procedures are performed that are not typically reported together.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified healthcare professional. Use this modifier if the rapid desensitization procedure needs to be repeated on the same day by the same provider.
4. Modifier 77: Repeat procedure by another physician or other qualified healthcare professional. This modifier is applicable if the procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically associated with procedures like rapid desensitization, if a diagnostic test related to the procedure needs to be repeated, this modifier may be used.
6. Modifier 22: Increased procedural services. If the rapid desensitization procedure required significantly more effort or time than usual, this modifier may be applied to indicate the increased complexity.
Each modifier should be used in accordance with the specific guidelines and payer policies to ensure accurate billing and reimbursement.
CPT code 95180, which pertains to rapid desensitization, is subject to reimbursement considerations under Medicare. To determine if this specific CPT code is reimbursed by Medicare, healthcare providers should refer to the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services and their corresponding reimbursement rates, which are updated annually. Additionally, it is crucial to consult with the local Medicare Administrative Contractor (MAC), as they are responsible for processing claims and can provide guidance on coverage specifics, including any regional variations or additional documentation requirements that may affect reimbursement for CPT code 95180.
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