CPT code 95165, 95144, 95170 Billing Samples

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Allergen Immunotherapy Coding Guidelines – Palmetto GBA Medicare
CPT code 95165 Billing ExceptionsIf the antigens, i.e., mold and pollen, cannot be mixed together, Palmetto GBA calculates the practice expense (PE) for mixing a multi-dose vial of antigens based on the following observed practice method:
  • Physicians usually prepare a 10 cc vial and remove aliquots with a volume of 1 cc
  • 10, 1 cc aliquot doses equal the entire PE component for the service
  • Size or number of aliquots removed do not alter the PE for the service
CPT code 95165 Billing Samples
  • To bill a 10 cc multi-dose vial filled to 6 cc with antigen, submit CPT code 95165 with 6 in the days/units field
  • If a physician removes ½ cc aliquots from a 10 cc multi-dose vial for a total of two doses, submit CPT code 96165 with 10 in the days/unit field. (Billing for more than 10 doses represents an overpayment for the practice expense vial preparation.)
  • If a physician prepares two 10 cc multi-dose vials, submit CPT code 95165 with 20 in the days/unit field. (The number of aliquots removed from the vials does not change the number of doses billed.)
CPT codes 95144-95170 Component Billing
  • Services for CPT codes 95144-95170 represent a single dose
  • To bill, specify number of doses in the days/units field
  • Use a code below the venom treatment number only for ‘catch up’ purposes
  • If a physician prepares the allergen and administers the injection on the same date of service, bill the appropriate injection code (CPT codes 95115-95117) and the appropriate preparation code (CPT codes 95145-95170)
  • Do not bill CPT code 95144 and an injection code (CPT codes 95115-95117)
CPT code 95144 Billing Samples
 Sample 1:
  • Allergist bills CPT code 95144 and two in the days/units field to indicate preparation of two single-dose vials of extract
  • Primary care bills CPT code 95117 and 1 in the days/units field to indicate the administration of two or more injections
Sample 2 *Component Billing:Allergist prepares a 10-dose vial and develops a schedule to administer one dose per encounter over a predetermined period of time.
  • Bill CPT code 95145 with 10 in the days/units field for the preparation
  • Bill CPT code 95115 for one injection