Otolaryngology Coding Alert

Question: When a patient undergoes intradermal dilutional testing, should we report 95027 by antigen or per dilution (test or stick)?

Vermont Subscriber

Answer: CPT^® code 95027 (Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests) describes when the provider introduces sequential and incremental airborne allergenic extracts into the skin to determine if the patient has an immediate allergic response.

The intradermal testing described by code 95027 may employ four or five dilutions of increasing concentration. You should report 95027 based on the number of sticks or tests performed per allergen at the various levels of dilution. For example, if a physician administers 10 allergens at four concentration levels for each antigen, report 95027 with 40 units of service. But beware, many third-party payers limit the total number of 95027 units you can bill at a time.

Note: Code 95027 includes a physician’s test interpretation and report, so you should not report these separately as evaluation and management (E/M) services.