Proper Coding and Reimbursement on CPT 95165

Can someone please explain to me how this to code this properly and how it is reimbursed by most payers?

Allergy

https://www.noridianmedicare.com/cgi-bin/coranto/viewnews.cgi%3fid=EkukyZuEpyEbJWxQaJ&tmpl=part_b_viewnews&style=part_ab_viewnews

Thanks for the answer

Thanks so much for the answer. Truly helped.

Proper Coding and Reimbursement on CPT 95165

While Medicare has it's own rules for 95165, CPT (and many payors) do not follow Medicare's rules. Therefore, you would report 1 unit on the claim for for each dose (whatever size that dose is). For example, if a 10 cc vial had 20 doses of 0.5cc each then CPT and non-Medicare payors would say to report "20" in the units box. However, Medicare says to report 10 units because Medicare considers a "dose" to be 1 cc even if the real dose is less.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com