Wiki 96165 Billed at time of mixing or injection

[rita_n_john]

We have an allergy provider who is mixing allergy injections prior to the patient visit. He is wanting to bill 96165 to insurance if the patient does not show up for the injection. Do you typically bill the mixing of the allergy med ahead of the patient visit or only bill at the time of the injection? I cannot find any guidance as to when the mixing should be billed but from all documentation I do see, it looks like it should be billed based on how much is pulled from the syringe at the time of injection, which would mean the provider cannot bill ahead of time. Any references would be helpful.

 

[Christal]

Each insurance has there own limits on units. I know Medicare is 30 units. We have the serum mix (95165) prepared prior to the patient coming in and we bill the # of units mixed on the date they are mixed. We only bill for the injection 95115 or 95117 the day they come in for the injections.

 

[Hchernandez]

Each insurance has there own limits on units. I know Medicare is 30 units. We have the serum mix (95165) prepared prior to the patient coming in and we bill the # of units mixed on the date they are mixed. We only bill for the injection 95115 or 95117 the day they come in for the injections.

Hi Christal - how often can you bill out the 30 units, say we have 150 units can we bill it in increments of 30 for five consecutive days?

 

[Christal]

Hi Christal - how often can you bill out the 30 units, say we have 150 units can we bill it in increments of 30 for five consecutive days?

I would check with the payer but with Medicare you could bill it out daily with 30 units. We billed most payers daily. I believe Aetna allowed more than 30 units. i am no longer billing for allergy and this how we billed in March.