Wiki Can you bill 94150 with 95115/95117

[lemorford]

Our allergy clinic started billing 94150 along with the allergy injections (95115,95117) and we are getting denials on 94150 for unbundling. Is anyone else billing these codes together and getting them paid? There are no CCI edits, but 94150 does say it is a separate procedure...do I just need to add a 59 to the 94150 or is it truely bundled with the allergy injections? Any insight would be greatly appreciated!!! Thank you!!!

 

[boomba003]

94150 is a Status B code for Medicare, Medicare Advantage and Medicare HMOs. Status B codes are always bundled in any procedure and are not payable and have no RVUs. Recommend going to CMS.Gov , enter RVU in search box and download "Addendum B-Relative Value Units and Related Information Used in CY 2017 Final Rule". Download How to Use MPFS booklet on the definitions of the Status codes in column C of the RVU file.

The only way to know if commercial insurances will pay is to see if the code is in their fee schedule.

Using a 59 modifier will do no good in this case.

wklyn@roadrunner.com