Dose Counts Matter When Billing 95165
Is your practice billing the number of services for Allergy Immunotherapy CPT® code 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses) correctly? The Comprehensive Error Rate Testing (CERT) Payment Safeguard contractor, AdvanceMed, seems to think not, and has put Medicare contractors on the alert.
Report CPT® code 95165 for preparation of multidose vials of non-venom antigens in addition to the appropriate injection code(s).
When reporting 95165, however, be careful how you count doses. According to the Internet Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Sect. 200.B.7, “a physician’s removing 10 1 cc aliquot doses [from a 10 cc vial] captures the entire PE [practice expense] component for the service.”
The practice expense payable for the preparation of a vial remains the same regardless of the size or number of aliquots removed from it. Report CPT® 95165 for no more than the total number of doses contained in the vial. Reporting the correct number of doses ensures proper payment.
For example, if a physician prepares a 10 cc multidose vial and removes ½ cc aliquots for a total of 20 doses, the most you can bill Medicare for is 10 doses.
Likewise, if a physician prepares a 20 cc multidose vial and removes 2 cc aliquots for a total of 10 doses, you should bill Medicare for 20 doses. Reporting only 10 doses would result in an underpayment to the practice.