Wiki Allergen Immunotherapy 95165

[lmcbrayer]

Code 95165 Preparation and Provision of Antigen for Allergen Immunotherapy

Need help determining doses per vial. Does anyone have the guidelines for various carriers or would you share how you determine and bill your doses?

 

[SUEV]

Info on doses per vial

Here's CMS's guidelines on antigen billing. The dosing info starts on pg 191
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
I hope this helps. I haven't been able to find similar information from other carriers so I use this info as the guideline.

Sue

 

[Erica1217]

This one is really good, too:
http://www.medicarenhic.com/news/provider_news/mbr_sept07.pdf

Does anyone have a documentation template for this service?

How are your providers documenting?

Thanks!!!
Erica

 

[dsilas@bcbsm.com]

I am seeking information and clarity on how to document wastage in the case of a single patient – multi dose vial. The environment would be for an allergists’ office. It seems there should be measures that can track antigen serum preparation, administration and wastage.

As an example, it is not uncommon to see CPT PC 95165 billed with a qty of 180 and the vaccine administration form indicating 48 doses were used. The documentation does not indicate wastage of the remaining 132 doses. The third party payer has paid the provider for the serum preparation although it was not all dispensed to the patient.

I would love to see a documentation template for 95165...other than Medicare.

Thank you,
Diane