Wiki 95165 Optum Denials

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it sounds like they want the administration of the allergen therapy coded as well.

per EncoderPro (emphasis added by me):
These codes report the physician's preparation of an antigen for allergen immunotherapy and the provision of the antigen extract itself. These codes also include the providing physician's calculations for the concentration and volume to be used in the dosage based upon the patient's previous skin test results and personal history. These codes do not, however, include the administration of the allergen therapy. The number of doses must be specified and the vial(s) (series of vials from a treatment board or one multiple dose vial) from which the dose may be drawn is irrelevant. Report the code based on the type of preparation, i.e., the number of different venoms contained in a single administered injection of the extract. Report 95145 for a dose containing one single stinging insect venom, 95146 for an extract containing two single stinging insect venoms, 95147 for three, 95148 for four, and 95149 for five single stinging insect venoms in one dose extract. Code 95165 reports single or multiple antigens (not stinging insect), and 95170 is for a whole body extract of a biting insect or other arthropod.
 
WITH THE COMMERCIAL PLANS AS OF JANUARY 2023 THEY DON'T COVER HOME THERAPY SO ALL THOSE PATIENT HAS TO PAY AS SELF PAY. THE WELLMED/UHC THE TROUBLE I AM HAVING IS THEY ARE ONL ALLOWED 30 UNITS PER 120 DAY PERIOD. WE SEND THE MR AND MIXING LOGS, STILL NOT PAID.
 
It took us a good minute to finally figure out EXACTLY what we needed for the medical records with every single detail they want. So we send the OV where the Immunotherapy formula was determined (The ov with the ST), A letter dated the date of the Serum being billed that has the formula, the number of vials, the breakdown for each vial along with the EXP date, Lot#'s and the Manufacture information. Example is below. The Mixing and the Prescription logs as well as a "Reference Key" explaining what (V) means or NAZ. We only send the medical records for anything over 30 units per day

Your company Name
Your company Address
You company Phone

Visit Note- Serum Billing
Provider:
Date of Service: Aug 07, 2023
Patient: Sex:
DOB: Age:
Insurance: Optum Care
Diagnosis:

Immunotherapy Formula:
This is where we would put the formula from the OV with the testing

The highest concentration vial ("Maintanance vial") is made, then weaker dilutions are made from that vial to create a building schedule. Each vial/formula ordered by the provider requires 30ml (units) to be prepared. The ESTIMATED number of individual doses per 30 ml vial is 30-33 administered doses if the patient is compliant and follows protocol every 1-2 weeks for the 6-12 month time period. Vials expire 6-12 months after preparation date depending on vial strength.

Vial(s) Prepared:

vial: ** ADD VIAL CONTENTS HERE

1:1000000 #6 5ml EXP
1:100000 #5 5ml EXP
1:10000 #4 5ml EXP
1:1000 #3 5ml EXP
1:100 #2 10ml EXP

Lot # EXP
Lot # EXP
Manufacturer:


Vials prepared by
This visit note has been electronically signed off by
 
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