95117/95165

[Revenuecycle]

We are a provider based clinic in NY. NGS is denying our 95165 because they say the information doesn't support the frequency/units of this service. Does anyone know how to bill for this, what are the allowable units on this code. We are being paid on the 95117 but the 95165 is denying on the institutional side for the frequency.

Any help would be appreciated.

 

[sarah.medicalcoder]

I would check your LCD guidelines on Allergy Testing and Allergy Immunotherapy on www.cms.gov.

https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/34597_9/L34597_ALRG001_BCG.pdf

 

[tkantor]

Allergy immunotherapy

Can anyone help? According to the Medicare Benefit Policy Manual Chapter 16 90.b
A reasonable supply of antigens is considered to be not more than a 12-month supply of antigens that has been prepared for a particular patient at any one time.
If medical practice prepares antigens for immunotherapy in accordance with the plan of treatment for 12- months period but after several injections patients do not come as they should. If Medical practice would be responsible for expenses related to the prepared antigens which were not administered due to patients no show? How the practice can be protected from such kind of financial losses? Is this allowed to use ABN form and bill the patient for the antigens prepared which were not used due to patient's no show?

 

[k.vawter@yahoo.com]

95117 & 95165

In our office we bill 95115 for the injection. Sometimes a patient will need two separate shots in the beginning to separate the mold from the grasses etc., we still only bill 1 unit. Serum billed on the same day has not been a problem. It depends on how often they get a injection, some every week some every two weeks. Typically we bill 95165, 12 units about every 3 months (average).