Allergy Testing - CPT 95004 - 95078
1. The MPFSDB fee amounts for allergy testing services billed under codes 95004-95078 are established for single tests. Therefore, the number of tests must be shown on the claim. EXAMPLE If a physician performs 25 percutaneous tests (scratch, puncture, or prick) with allergenic extract, the physician must bill code 95004 and specify 25 in the units field of Form CMS-1500 (paper claims or electronic format). To compute payment, the Medicare carrier multiplies the payment for one test (i.e., the payment listed in the fee schedule) by the quantity listed in the units field.
2. Part B providers indicate the number of tests (one for each antigen) in Box 24G of the HCFA 1500 claim form. On EMC claims enter the number in the service field.
3. Interpretation of CPT codes: 95004 -95078; use the code number which includes the number of tests which were performed and enter 1 unit for each test performed. For example, if 18 scratch tests are done, code 95004 with 18 like services. If 36 are done, code 95004 with 36 like services.
4. When photo patch tests (e.g. CPT code 95052) are performed (same antigen/same session) with patch or application tests, only the photo patch testing should be reported. Additionally, if photo testing is performed including application or patch testing, the code for photo patch testing (CPT code 95052) is to be reported, not CPT code 95044 (patch or application tests) and CPT code 95056 (photo tests).
5. Non-covered testing: Non-covered services include, but are not limited to, the following services (some are not represented by specific CPT-4 codes). Some of these are based on statute and this is noted in italics.
Medicare Payments, Reimbursement, Billing Guidelines, Fees Schedules , Eligibility, Deductibles, Allowable, Procedure Codes , Phone Number, Denial, Address, Medicare Appeal, EOB, ICD, Appeal.
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list

Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
CPT CODE and Description CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires thes...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
URIBEL- methenamine, sodium phosphate, monobasic, monohydrate, phenyls alicylate, methylene blue, and hyoscyamine sulfate capsule Uribel i...
-
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
LAPAROSCOPY ; LAPAROSCOPIC SURGERY Procedures and Related CPT and ICD-9 Procedure Codes CPT Code CPT Description ICD -9 ...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
-
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
procedure code and description 11042 -Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm ...
-
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
-
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt...

No comments:
Post a Comment