tswitzer
New
We have had a physician (ENT) supervised allergy program for about five years, where we were mixing our own allergy serums, and billing out per dose based of vials mixed using 95165x10 per vial mixed. We then billed the 95115 for single immunization and 95117 for two or more immunization each week in office. Our new ENT and practice manager are working with an outside pharmacy they provided us initial vial that is concentrated, and he is diluting here in clinic, but once we are fully set up, that will be providing testing materials, then once that has been done mixing and direct billing us for the serums. I am wondering going forward how we properly bill for the serum, since we are not mixing ourselves, to pass the cost onto the patient/insurance. I am assuming we will continue to bill the testing like we always have as 95004 for the puncture/prick tests per allergen, but not the serum mix/provision with the 95165 per dose. I don't know what codes to use. I found 95120 and 95125 which talk about the supervision of the immunotherapy with provision of the serum, but it does not look like those codes are supported by Medicare, so not sure if I am looking in the right place.