I'm working for an ENT practice, and we need to know the appropriate way to bill Medicare for 95165. We start with 2 10cc vials (one environmental and one pollen), and then dilute the serums into 6 different sets of vials, one set of 6 for environmental extracts and one set of six for pollen extracts. Medicare only allows billing 20 units per claim for this scenario (10 per vial). Do we bill 20 units for 6 different service dates to cover all the serums. If they ask for records, our original mixing log will only have the first service date, so how do we provide documentation for the other service dates for the remaining claims? Any advice or direction would be appreciated!
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Wiki Billing 95165
- Thread starter Rbbeatty
- Start date
OpenClaims
Guest
Hello,
When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial, which is allowed under code 95165. So, you would specify the number of doses for that particular DOS.
You can find additional medicare information regarding this topic at: https://medicarepaymentandreimburse...n ten preparations are obtained from the vial.
According to medicare, "the physician should make no change in the number of doses for which he/she bills even if the patient’s doses are adjusted. The number of doses anticipated at the time of the antigen preparation is the number of doses that should be billed. If the patient actually receives more doses than originally planned (due to a decrease in the amount of antigen administered during treatment) or fewer doses (due to an increase in the amount of antigen administered), no change should be made in the billing."
Hope this helps.
When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial, which is allowed under code 95165. So, you would specify the number of doses for that particular DOS.
You can find additional medicare information regarding this topic at: https://medicarepaymentandreimburse...n ten preparations are obtained from the vial.
According to medicare, "the physician should make no change in the number of doses for which he/she bills even if the patient’s doses are adjusted. The number of doses anticipated at the time of the antigen preparation is the number of doses that should be billed. If the patient actually receives more doses than originally planned (due to a decrease in the amount of antigen administered during treatment) or fewer doses (due to an increase in the amount of antigen administered), no change should be made in the billing."
Hope this helps.
Christal
Networker
We bill out antigen mix as well (95165). Per Medicare you only bill 10 doses per vial. The number of units is 1cc of the dose being prepared. If you prepare a 10cc vial then you bill 10 units. If you prepare 5cc vial you bill 5 units. Medicare will not cover the diluted vials that are prepared from the maintenance vials. Also Medicare only allows 30 units a day when mixing.