Sublingual Immunotherapy-Is anyone billing

DawnTaddeo

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Sublingual immunotherapy

My understanding is that sublingual immunotherapy is still considered investigational and not billable or covered by any payer.
 

Thouvenel

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There isn't a code for sublingual drops, but I have successfully received reimbursement from insurance companies using the unlisted code and attaching the office note. I always verify with the insurance that it is covered before ordering the serum.
 

sisadavis

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Our office has been successfully billing SLIT for the past year now using CPT 95199 Unlisted allergy immunologic service/procedure. We also make our own serum. About 30% of our patients are covered, even though the therapy has yet to be FDA approved. To my surprise, most UHC plans are covering, as well as Aetna and Cigna. Not too much luck with BCBS, just self funded plans. Everyone signs an ABN type waviers in the event their carrier will not pay, they know they are expected to cover it themselves. Most our SLIT patients would rather pay out of pocket then go through injection therapy.
 

CMENT

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Slit

We have been billing out slit for several years, our State Plan backed by UHC covers them, so I'm going to assume that they on their policy covers investigational therapy of any kind. BCBS is iffy on payment, we mail hcfas with letter of necessity and notes. Aetna now is giving us problems but at least some are paying. It is a big headache though. J30.89 and T78.40xd and 95199 with sublingual antigens as description. Most insurances pay on them as pharmacy. This is an FYI to all.
 
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