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ALLERGY TESTING CODE 95024

Billing Posted Thu 24th of July, 2014 14:17:49 PM

OUR OFFICE HAS SUBMITTED A CLAIM TO CONNECTICUT MEDICARE FOR CODE 95024 WITH 43 UNITS AND CODE 95004 WITH 40 UNITS. MEDICARE DENIED THE CLAIM LINE 95024 STATING EXCEEDS MAXIMUM NUMBER OF UNITS. I CALLED MEDICARE TO ASK THEM WHERE IT IS PUBLISHED THAT SHOWS THE MAX # OF UNITS FOR THIS CODE AND WAS TOLD THAT THERE WAS NO PUBLISHMENT, HE SAID I WASN'T OFF BY MUCH BUT HE COULD NOT TELL ME THE MAX # OF UNITS. CAN ANYONE TELL ME WHAT THE MAXIMUM # OF UNITS ARE?

SuperCoder Answered Fri 25th of July, 2014 09:24:52 AM

Thank you for your question.
You can check your local Medicare LCD for utilization guidelines. Below is an LCD example that I was able to locate, it may be of of some help:

The selection of antigens should be individualized, based on the history and physical examination.
Medicare expects that all patients will not be tested for the same antigens or receive the same number/type of tests.
Medicare would not expect that more than 75 percutaneous tests per year are medically necessary for the management of an individual patient. More than 75 tests per year may be allowed upon review when the clinical circumstances documented in the patient's medical record substantiate the need for additional tests.
Medicare would not expect that more than 20 intradermal tests per year are medically necessary for the management of an individual patient. More than 20 tests per year may be allowed upon review when the clinical circumstances documented in the patient's medical record substantiate the need for additional tests.
Medicare would not expect that more than 30 tests per year are medically necessary, for code 95017, for the management of an individual patient. More than 20 tests per year may be allowed upon review when the clinical circumstances documented in the patient's medical record substantiate the need for additional tests.
Medicare would not expect that more than 12 tests per year are medically necessary,for code 95018, for the management of an individual patient. More than 20 tests per year may be allowed upon review when the clinical circumstances documented in the patient's medical record substantiate the need for additional tests.

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