Wiki How to bill for providing and administering allergy immunotherapy

[hsmith67]

We are getting premixed vials of allergen immunotherapy and the vendor bills us for the premixed vials.
We pay the vendor and then we administer the immunotherapy. As the vials are sent premixed, the provider is not doing any aliquot/preparation of the immunotherapy, only in the very rare case of a patient reaction does he do an aliquot.

Assuming no preparation is done, only providing and administering, what codes are used to bill insurance to get us paid for:
1) Providing the immunotherapy (that we paid the vendor to premix and provide/we paid the vendor), and
2) Administration (95115 or 95117) - I'm good with the admin fee, I just believe 95165 is not correct since the immunotherapy was sent premixed from the vendor.

Thanks for any assistance!
Hunter Smith, CPC

 

[djolly]

95120-95134 includes professional services like 95115-7 and it includes the provision of the allergenic extract. Is this what is premixed?

 

[lataashwini23@gmail.com]

Hi i work for urgent care and trying to bill 95117 to medicare with 2 units, that is the only code on the claim but i am getting error when billing the claims out (procedure code 95117 units are not according to medicare unlikely units edits).

 

[JoaniePerkins]

95120-95134 includes professional services like 95115-7 and it includes the provision of the allergenic extract. Is this what is premixed?

Good afternoon. I'm still a little unclear on the 95165 billing. I don't see why the ENT who sends the pharmacy lab the allergenic extract orders, pays for them, and confirms receipt (right patient, right therapy) isn't the one who should bill 95165. I don't know that intention of code 96165 implies it must be the ordering ENT actually mixing the antigens under the hood, rather than providing professional supervision that the preparation was in accordance with his/her orders once it is received. By contracting with a compounding pharmacy, sending and receiving the orders, doesn't that constitute as "supervision" of preparation and provision? To me it's a similar situation to any purchased diagnostic where the ordering provider pays the contractor and bills the payer/patient.
Appreciate any comments - Stay safe out there!

 

[nmilford]

Good afternoon. I'm still a little unclear on the 95165 billing. I don't see why the ENT who sends the pharmacy lab the allergenic extract orders, pays for them, and confirms receipt (right patient, right therapy) isn't the one who should bill 95165. I don't know that intention of code 96165 implies it must be the ordering ENT actually mixing the antigens under the hood, rather than providing professional supervision that the preparation was in accordance with his/her orders once it is received. By contracting with a compounding pharmacy, sending and receiving the orders, doesn't that constitute as "supervision" of preparation and provision? To me it's a similar situation to any purchased diagnostic where the ordering provider pays the contractor and bills the payer/patient.
Appreciate any comments - Stay safe out there!

Did you get a resolution for this or confirmation of how to bill when the antigen is from a compounding pharmacy? I am also trying to work this out.

I appreciate any help that you could give.