# Billing for the entire bottle of Allergy Serum



## AKAJBART

We?ve recently had some issues with patients coming in for allergy injections, after we?ve ordered the serum specifically for them, and then they?re not returning as they should.  Leaving us to waste, and write off  the cost of their bottle of Allergy Serum.  

My question is: 
1)	Can we charge a patient (self pay) or their insurance, in advance for the entire bottle of serum?.. and then only charge the injection fee when they return for individual injections?
2)	For Medicare, we can have them sign an ABN, but what could we do to protect ourselves for the commercial payers and self pay?


Any help would be appreciated! 
Thanks.


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## BABS37

Hi AKAJBART. Are you billing for both the allergy testing and the  immunotherapy? Medicare, UHC, BlueCross and commercial payers have exact specifications on how these charges should be billed out.  

When patients come back in for their first two or three visits, its for them to get comfortable with self-administering the drug themselves so you wouldn't bill for an administration fee. It's included, especially if they are seeing the allergist and not the physician. Remember, the whole set up in the cost of allergy billing is so the patient can provide their own treatment at home. 

There are several ways to enter the charges based on carrier. I am in Iowa. Here is how we do it by payer and this is strictly an example- we provide testing for 50 allergies and inject up to a total of 300 units for our serum:

01/01/2014
95004 times 50 units-Patient comes in for _scheduled_ allergy testing. Testing comes back and we are going to proceed with immunotherapy services for one year. 

Depending on the insurance, here's how we bill for the serum:

Commercial: 1 claim with 300 units

CIGNA: 1 claim with 300 units


UHC: 4 claims each with 75 units consecutive days (Patient does not need to be present for billing) so it would look like this:
01/02/2014 95165 times 75 units
01/03/2014 95165 times 75 units
01/04/2014 95165 times 75 units
01/05/2014 95165 times 75 units

AETNA: 1 claim (They will only pay us for 120 units for first yr treatment)

HUMANA: 3 claims each 100 units totaling 300 consecutive days

TRICARE: 3 claims each 100 units totaling 300 consecutive days

MEDICARE: 7 claims each with 20 units consecutive days  

Remember each insurance carrier may also have a set limit of units they will pay for, either by year or by month. Medicare will only pay for 20 units per claim billed every 30 days. Humana is 100 units per claim billed every 30 days ... it would be advised to check with your allergy carrier who supplies the serum for billing guidelines as well. They should provide you with that information. 

Also, note the rule for billing E/M with allergy testing and immunotherapy same day. Hope this helps!


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## AKAJBART

Yes, we do the allergy testing prior to the immunotherapy to confirm what in fact the patient is allergic to.

We're not going to be sending the drug home with the patient, so we're not teaching them how to administer.  We'll be administering it ourselves in the office.  

So are you saying that it is appropriate to bill the whole regimen of allergy immunotherapy up front (95165)?  And then when the patient comes in for the injection, we'll bill the injection only on that day (95115 - for 1, and 95117 for two)?

You mentioned "300" units, how would I figure out how many should be billed for each patient?  The code says: "Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)". Is each cc a dose, or each antigen a dose?  

Thanks so much for your help.  Sorry, these are probably stupid questions to you, but I just want to make sure that things are billed correctly.  And in order to do that, I need to fully understand the rhyme and reason for all of this.  

Thanks!


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