- Outpatient Institutional Providers Reimbursed Under MPFS: When to Split Claims for Updated Rates
- Outpatient Services for Registered Inpatients
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
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- Fiscal Year/Calendar Year Claim Split
Allergen Immunotherapy Preparation (95144‑95165)
National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, please note that if auxiliary staff prepares the antigens the physician must provide direct supervision for the services for that employee in order to bill for the service.
These codes are defined as requiring a physician’s supervision for the preparation and administration of the antigens. As mentioned previously, this requires direct supervision. This means that, in the office setting, the supervising physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.
The CMS will allow Medicare payment for a reasonable supply of antigens that have been prepared for a particular patient if:
- The antigens are prepared by a physician who is a doctor of medicine or osteopathy and
- The physician who prepared the antigens has examined the patient and has determined a plan of treatment and the dosage regimen.
Please note that CMS has also determined that a reasonable supply of antigens is considered to be not more than a 12 month supply prepared at any one time.
Please refer to the CMS IOM Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.1 for the requirements.
Reviewed 8/28/2024