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Reader Question: Appeal Inappropriate Edit of 95117 and 95165

Question: One of our carriers always denies 95165 as inclusive to 95115. Since we have a contract with this carrier, we had not been billing secondaries or patients for 95165. How can we get paid for preparing the serum?

Nebraska Subscriber

Answer: The edit of 95115 (or 95117) and 95165 (professional services for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) is inappropriate and should be appealed. Not only are these two codes not bundled, code 95115 clearly states in its descriptor that it does not include the provision of allergenic extracts, which is reported by 95165. If the carrier still refuses to pay separately for 95165, an independent Fair Hearing appeal should be requested. As long as the services are correctly documented, the denial should be overturned.

- Published on 2001-09-01

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