Wiki ALLERGY MIXING 95165

[Nina@medibillers.com]

Hi everyone, Hoping to find a coder/biller for allergy. How do you handle the mixing. Insurances only allow so many units and if you make the full dose for the year, you are out of luck getting paid for the full amount. I am in Michigan.
I am going to try billing one line with units that are allowed by each insurance and then a second line with the difference with 59,76??

 

[Cbaxter001]

Howdy! It depends on how your practice is set up, Medicare has a MUE of more than 30 units for CPT 95165 so we bill the insurance company as we mix our multi dose vial, for example on the 1st we mixed a 5cc vial so we would bill 95165 x5 units only (because the patient does not have to be there for us to mix it) and say the patient is scheduled to come weekly we bill the allergy administration (95115x1 unit or 95117x unit ) for 5 weeks and then the vial runs out and we mix again based on the strength and we bill 95165 separately again. It's a little tedious to keep up with the units billed vs units used but it's worth it because we can receive payment for the entire schedule. It's worked out for a lot of our payers, I only encounter denials when we do the rapid desensitization because not everyone covers it or will cover the large amount of allergens mixed for the procedure.