Wiki CPT code 95165

KDMarshall

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We have a Dr who is trying to code out 300 units of 95165. Is there a maximum allowed number of units on this code? It doesn't say so in the CPT book, however after some research there are some sites that state you can only code 10 units. Any advice or knowledge of this code would be greatly appreciated! Thank you!!
 
The limit for Medicare is 10 units. 1 unit is equal to 1cc no matter what the actual dose is.

BCBS recently imposed a limit of 10 units. This was in the provider newsletter for September 2013.

As for other carriers, I'm unsure of the limits at this time. I was informed by a representative at the JCAAI that many carriers are in the process of imposing these "caps" so if there is not one currently, most likely there will be one soon.
 
Cpt 95165

I have a Allergist who is coding 95165 with 10 units. The patient then comes back for the rest of the injections the physician then codes 95115. I keep getting a rejection for a supply code. Should the 95165 be billed with a J code. When the patient comes in for the rest of the injections 95115-95117 should a J code be added to this as well?

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Tanille Aponte CPC
 
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