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Outsourcing Compounding- 95165

Ashanti Posted Thu 04th of June, 2020 06:56:41 AM
Can a physician bill for CPT 95165 when the compounding is outsourced and the vendor does not submit it's own bill to the insurance carrier but bills the practice instead? Could this be considered supervision since the physician is requesting the formulation/ratio of antigens for each vial? The description of CPT 95165 uses the word "OR" ... An allergist or other supplier prepares or supervises the preparation of multiple dose vials of antigens for allergen immunotherapy. Thank you!
SuperCoder Answered Fri 05th of June, 2020 12:16:37 PM

Hi Ashanti,

Immunotherapy (desensitization, hyposensitization): is the parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale to a dosage which is maintained as maintenance therapy. Indications for immunotherapy are determined by appropriate diagnostic procedures coordinated with clinical judgment and knowledge of the natural history of allergic diseases. Allergen immunotherapy involves the periodic, gradual administration of purified allergen extracts via injection, with the aim of overcoming or minimizing allergic reaction, so that a patient can develop tolerance to the allergens with fewer or no symptoms. An allergic reaction is the result of the body's reaction to a specific substance that otherwise seems to be quite harmless, but can cause a severe reaction in a person allergic to the substance. Allergy shots decrease the sensitivity to allergens and often lead to lasting relief of allergy symptoms. The codes 95615 reports the physician's preparation of an antigen for allergen immunotherapy and the provision of the antigen extract itself. These codes also include the providing physician's calculations for the concentration and volume to be used in the dosage based upon the patient's previous skin test results and personal history. These codes do not, however, include the administration of the allergen therapy. The number of doses must be specified and the vial(s) (series of vials from a treatment board or one multiple dose vial) from which the dose may be drawn is irrelevant. Report the code based on the type of preparation, i.e., the number of different venoms contained in a single administered injection of the extract. Hence, as per explained guidelines, the physician can bill the service one unit of 95165 for each dose of antigen prepared. Also, please check the contract and/or policy under which physician and vendor are bound to get the payment and bill accordingly.

Hope this helps!

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