Question Allergy 95165 and 95180

[klen]

Hi All,

I thought I posted this question yesterday, but I don’t see it in the forum so maybe I did it wrong. Anyway, my provider bills rapid desensitization procedure as follows:

95180 – rapid desensitization procedure; each hour

95165 -professional services for supervision of prep and provision of antigens for allergen immunotherapy (multiple units, up to 27 but not exceeding 30)

95117- professional services for allergen immunotherapy; 2 or more injections

We are receiving denials on code 95165 (mostly from UHC/Optum) stating “the number of units of service exceeds our acceptable maximum”. We can think of two scenarios which would cause this:

• The prep of the antigens is included in 95180 in which case 95165 is bundled and not reimbursable or
• We have exceeded the total number of antigen services (30) in the month in which the desensitization service took place (our patients usually have maintenance allergy shots within the same month of the rapid desensitization, which would cause them to go over 30 units).

If we know what's causing our denials we will know how to fix the issue, but so far we are going around in circles on the issue.

Any thoughts you all might have would be appreciated on which one (or both) would be appreciated.



Thanks!