Otolaryngology Coding Alert

Question: What's the acceptable number of units to bill for allergy vials for Medicare patients? If we mix a 5 cc vial that has 10 doses, do we bill for five or six doses?

Ohio Subscriber

Answer: Medicare only allows you to bill for undiluted units of antigen (95165, Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]). For an allergy vial, the most you can bill for Medicare is five units.

Stay on your toes: This is not true for many non-Medicare payers. For them, you can bill 95165 times the actual units in the vial that you provide to the patient; so, if, with dilutent, the vial will deliver eight allergy doses, you can bill non-Medicare payers eight units.

Keep them separated: Have a policy on how to bill 95165 for Medicare and non-Medicare payers. Keep in mind you may receive letters from non-Medicare payers that they expect you to follow Medicare's rules. Then you should bill those payers a maximum of five units.

-- Answers to You Be the Coder and Reader Questions provided and reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.