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Amy Posted Wed 27th of September, 2017 17:05:38 PM
How would you bill medicare/commercial insurance for the following scenario: Pt comes in for her allergy shot therapy. 7 5ml bottles will be made on the first date of service. She will go home with the first 2 bottles. Each bottle contains about 23 shots. We will be billing for all 7 bottles at the first date of service. How would we code this out for medicare with the correct unit value? We know we bill with 95165 however the way medicare/commercial billing definitions are very confusing. 8 antigens total in bottle 5ml bottle 7 bottles total for treatment Diluent is 4.5 Total volume is 5.3 Total shots for patient over course of therapy is 150 If the patient is allergic to mold and pollen she would have a total of 14 vials and about 300 shots for the course of the treatment.
SuperCoder Answered Thu 28th of September, 2017 02:40:40 AM

Hi,

 

While billing CPT code 95165, a dose is defined as a 1 cc aliquot from a single multi-dose vial. Providers should report the no. 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 (10) preparations are obtained from the vial. When a multi-dose vial is diluted, Medicare should not be billed for diluted preparations in excess of the 10 doses per vial allowed under code 95165.

 

Thanks.

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