Wiki Serum Billing 95165

[shain.mastroianni@allergyasthmaclinicltd.com]

Optum/UHC is denying - How are people billing this for new starts?

 

[Shana DuBois CPC]

I am also having issues with UHC & 95165... the only information I have been able to obtain, was thru Optum, and they are saying to refer to the CMS claims processing manual -




I am also looking to see how others are coding these and getting reimbursed by UHC/Optum.

 

[mackermann455@gmail.com]

Hi there. I have encountered this as well. It seems that if you include the mixing logs from the antigen therapy as an attachment, they will reimburse, sometimes. Usually however, this paperwork can be quite lengthy so the claim may auto drop to paper and take longer to process. UHC/Optum/Oxford is the ONLY insurance company that is giving me an issue with 95165. We have also encountered numerous take-backs from them as well.

 

[shain.mastroianni@allergyasthmaclinicltd.com]

Hi there. I have encountered this as well. It seems that if you include the mixing logs from the antigen therapy as an attachment, they will reimburse, sometimes. Usually however, this paperwork can be quite lengthy so the claim may auto drop to paper and take longer to process. UHC/Optum/Oxford is the ONLY insurance company that is giving me an issue with 95165. We have also encountered numerous take-backs from them as well.

We have always included the mixing logs with our records. They are stating now that they are denying due to they do not allow the diluent units

 

[krisandrew]

I am having the same issue in Louisiana. UHC and Peoples health are not paying our Serum claims if billed over 20 units (CPT Code 95165) I have appealed several claims still to be denied stating billing units exceeded as UHC does not cover dilution units. It is still part of mixing the Antigens and cannot get a UHC Rep to call me to discuss. SO FRUSTRATING!