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95165 - billing Medicare vs Private Payors

Melissa Posted Wed 04th of September, 2013 14:05:00 PM

For 95165 (billing for antigen prep), we use a 5 cc multi-dose vial. I know for Medicare, we have to bill 5 units. However, we are getting 10 doses out of the vial according to CPT and AMA. Can I bill private payors 10 units? Do practices bill 95165 differently or just adopt the Medicare methodology across the board?

SuperCoder Answered Thu 05th of September, 2013 13:10:47 PM

Please bear with us...we are researching this query.

SuperCoder Answered Thu 05th of September, 2013 13:10:47 PM
Am hoping a coder with confidence will be able to answer this.
SuperCoder Answered Fri 06th of September, 2013 13:45:56 PM

Definitely bill private payers differently from Medicare UNLESS they have a policy that states that they follow Medicare's rules for calculation of antigen.

So unless private payer says they follow Medicare rules for antigens, bill 10 units.

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