Wiki 95165 ALLERGY MIXING

[pfoster@caprimg.com]

If there is anyone who could please advise? I am in need of information with the billing of code 95165. We are getting records request and denials from Humana Medicare regarding this code. Does anyone know the correct units allowed per day and for how many days? what is the annual max units allowed? We bill for the year in the beginning of the patients treatment. ex 30 units for 06/01/2024, 30 units for 06/02/2024, 30 units for 06/03/2024 and so on. Also if you are a regular Allergy biller I would love to know max allowed annually by any other ins as well. Some will openly tell you the policy and others will not budge. Thanks in advance for any info please.

 

[zcometa]

Humana has a limit of 120 units/yr. That is every 95165 billed within a period of 365 days so not every calendar year. Blue Cross and Blue shield both have a max of 150 units/yr. BC has a daily max of 30 units and BS has a daily max of 25 units.

Of course, medial policies change fairly often, and these numbers need to be verified routinely.