- Change to Roster Claims Information Entry in the Fiscal Intermediary Standard System Direct Data Entry
- Drugs and Biologicals - Coverage and Billing
- Allergen Immunotherapy: Coding and Billing CPT 95165
- Medicare Part B Drug Coverage
- Covered Medicare Part B Drugs/Biologicals
- Self-Administered Drug Exclusion
- Medicare Part B General Billing
- Discarded Drugs/Wastage and JW, JZ Modifier
- Chemotherapy General Infusion Information
- Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility
- Reimbursement for Pre-exposure Prophylaxis Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus Infection
- Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)
- Compound Drugs
- Patient-Supplied or Free-of-Charge Drugs
- Prolonged Drug and Biological Infusions Using an External Pump
- Coding for Sinuva™ Claims
- Radiopharmaceutical Reimbursement
- Dermal Injections for Treatment of Facial Lipodystrophy Syndrome
- Factor VIII Billing
- Intravitreal Beovu (Brolucizumab-dbl) Billing
- Proper Billing for LEQVIO® HCPCS Code J1306
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Proper Billing for TEZSPIRE™ HCPCS Code J2356
- Proper Billing Units for HCPCS Code J7320
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Skin Substitutes
- Vaccines
- Related Content
Allergen Immunotherapy: Coding and Billing CPT 95165
CPT 95165 is defined as “Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses).”
A simple rule to observe is that a physician may only bill CPT 95165 for the number of times that correlates to the cc's contained in the fully prepared vial.
CMS recognizes that, in professional practice, a 10cc. multidose vial of antigens is often prepared, and physicians commonly remove 10 1-cc aliquots of the antigens for patient dosage administration.
The practice expense payable for the preparation of a 10cc. vial remains the same regardless of the number of aliquots removed from the vial, so a physician may not bill CPT 95165 for more than 10 doses per 10cc vial. This logic also applies when a vial of less than 10cc. is prepared. For example, when a 5cc. vial is prepared, the physician may not bill CPT 95165 for more than five doses of the antigen.
When medically necessary, preparation of more than one multidose vial is also billable and payable. For example, when two 10cc. vials are prepared, the physician may bill CPT 95165 for each of the 20 doses in these two combined vials.
Of note, the injection of the antigen remains separately billable and payable.
The addition of modifier 59 to each claim for CPT 95165 is incorrect and is not an acceptable practice, since it is understood that allergen immunotherapy involves multi-dose vials and that multiple aliquot extractions will be associated with each vial.
Posted 12/18/2024