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Otolaryngology Coding Alert

Reader Questions:

Payer Rules Differ On Incident To Services For Allergy Shots

Published on Tue Apr 19, 2011

Question:I'd like to get verification on billing for allergy testing (95004), allergen prep (95165), and allergy injections (95115 or 95117). Our nurse actually is the person doing all of these procedures and then the physician looks at the information at a separate time. Does a physician need to be present in the office at the time any of these procedures are being performed? New Mexico SubscriberAnswer: Allergy shots are a therapeutic service and thus falls under incident to services. This, therefore, falls under the incident to rules. This means that a physician or a non physician practitioner must be in the office suite when the injections are administered. You should bill the injections codes (95115 and 95117) under whatever provider is present in the office -- the physician or the non physician provider -- per Medicare rules. Preparation of the allergen serum (95165) and allergy testing are diagnostic services. They do not [...]
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