Wiki Cpt 95165-physician documents

[rodica moga]

On 10-10-12 the physician documents the preparation of 153 doses of antigen for one patient. We billed this to Medicare with 153 units for cpt 95165 and the claim was rejected. How will this be billed to Medicare and to commercial payers?
Any help is welcome.
Thank you

 

[Wendyh50]

Modifiers

17 line claim
modifier 59 on 16 lines and dont forget to use JW if necesssary
the rule is:
· CPT procedure code 95165 is used to report multiple dose vials of non-venom antigens. Effective January 1, 2001, for CPT code 95165, a dose is now defined as a one- (1) cc aliquot from a single multidose vial. When billing code 95165, providers should report the number of units representing the number of 1 cc doses being prepared. A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial. In cases where a multidose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial allowed under code 95165.

 

[rodica moga]

Thank you very much for your reply.