95134 and 95115

mariaher921

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Allergy injections -- BCBS is not paying for our 95134 code. We are putting modifier 25 on the 95134, but there is still not payment. Does anyone have any type of idea how to get this fixed? What modifier do we need to use?
Thank you!!
 

kathrynw

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Hi,

I am not seeing a NCCI edit for these two codes stating that they can't be billed together or that they need a modifier. Here are the lay terms for each, it might be helpful to check the documentation and make sure they fully capture the services.
95134- The provider administers stinging insect venom for five types of insects in the office to treat or prevent a reaction in a patient allergic to the sting.
95115- The provider injects the patient with allergenic extracts to desensitize the patient to the allergen; the patient receives a single injection during the visit.

It might be helpful to note that modifier 25 is for E/M codes only. You may need to look at a different modifier.

Here are a few helpful references about proper application of modifier 25.
 
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