Wiki Sublingual Immunotherapy

[Jenrusz]

Hi Everyone,
I work for an allergist and we are starting to provide patients with sublingual immunotherapy (Grastek by Merck). The patient brings the tablet and takes the first dose in the office and is observed for 30 minutes after. There is no code in CPT for this administration. Any suggestions on how this should be billed? Thanks!

 

[chriskhans]

Slit

Hi, I work for an allergist as well who administered this to a patient in the office the other day. From my research I have found there is not a CPT code for it and any information I have found refers to code 95199 Unlisted allergy/clinical immunology service or procedure.

My issue now is knowing how much to charge for this service. Since it's an unlisted code I haven't been able to find an allowable amount.

Please let me know if you have found any additional information.
Thanks!
Christy

 

[CMENT]

We bill out for Sublingual Therapy 95199 vials only, We submit paper claims (due to it being an unlisted procedure code) with information for medical necessity, however not all insurances cover it. If they don't we bill out to the patient a specific amount. We have our issues with insurances paying one time and then not paying another, therefore we tell the patients that we cannot guarantee insurance coverage. I have now encountered and issue with a medicaid that they want a modifier and I believe its 22, so with that being said I will continue on fighting for our patients with their allergy needs.