Otolaryngology Coding Alert

Question: How should I be billing out for SLIT drops? Is this procedure generally reimbursable or should the patient expect to cover the charges?

Georgia Subscriber

Answer: Sublingual immunotherapy (SLIT) drops have become a much more common alternative to traditional injection-based allergy treatment approaches. There are numerous benefits to this alternative treatment method. First, it prevents the patient from having to stop in to the physician's office on a weekly basis for injections. Second, the under-the-tongue drops are equally effective and do not cause the patient any discomfort.

As is expected with the implementation of this new allergy treatment method, numerous questions have been raised on how to accurately code and submit SLIT treatment to various payers. Since no current CPT^® code exists, you will have to report SLIT with the unlisted code 95199 (Unlisted allergy/clinical immunologic service or procedure). As is expected with an unlisted code, you should report this service both electronically (for timely filing) and on paper to further elaborate on the service performed.

Note: You may indicate in box 19 that the unlisted code 95199 is for sublingual immunotherapy.

While Medicare does not currently reimburse for SLIT drops, other insurance companies have been known to do so. While this may not universally be the case, there have been instances of payers like UHC, Aetna, and Cigna reimbursing for this service. If you are submitting to a commercial payer, you still should plan on submitting an advanced beneficiary notice (ABN) form as you would for a Medicare patient.

This form simply explains to the patient that, in the (often expected) case that the payer denies the service, the patient will be required to take full responsibility for the charge. Private payers may provide a form similar to an ABN via their website. If you do not have a payer provided form, it is recommended that the practice develop their own waiver for payment of non-covered services.