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Billing for multiple allergy vials on the same day - CPT code 95165

Marla Posted Thu 23rd of April, 2015 08:37:18 AM

How should you bill Medicare for 3 vials of allergy serum that were made on the same day. There are three separate 5 cc vials. We have been billing them as follows:
95165 - 5 units
95165-59 - 5 units
95165-59 - 5 units
We have recently been getting denials on the third line stating that it is duplicate billing because it appears exactly like line item 2.

SuperCoder Answered Fri 24th of April, 2015 01:02:49 AM

You can bill maximum 10 units with CPT 95165. Regardless of the number of vials prepared or injections performed during a single session, only one dose could be billed. For example, the provider could bill only 10 units of 95165 even though 20 1-cc doses had been prepared in two separate vials.

Marla Posted Fri 24th of April, 2015 13:47:45 PM

Do you mean a maximum of 10 units per day for CPT code 95165? Because, I have not found documentation to suggest a maximum number of units that can be billed per day for 95165. I understand there is a maximum of 10 units PER vial, however, as I indicated, we use 5 cc vials, so by combining 2 vials of 5 units per vial to equal 10 cc's - that indicates to them that I am billing only 1 vial of 10 cc. I am trying to communicate to them the most accurate information so we have separated them. Please clarify.

SuperCoder Answered Mon 27th of April, 2015 01:12:38 AM

Please read the below scenerio "Providers who mix more than one vial of antigen may now bill Medicare for the total number of doses in all vials, as long as that number does not exceed 10 per vial, according to a clarification by HCFA (now the Centers for Medicare and Medicaid Services, or CMS) in the Nov. 1, 2000, Federal Register. The clarification was necessary, the document states, to resolve "the ambiguity and confusion in the medical community surrounding this issue." For more information, please read the article https://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/regulations-ease-95165-billing-but-also-add-requirements-article

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