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SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Allergy Immunotherapy

A56424

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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General Information

Source Article ID
N/A
Article ID
A56424
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Allergy Immunotherapy
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/27/2022
Revision Ending Date
11/01/2023
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L32553-Allergy Immunotherapy.

 

Definitions

  • For allergen immunotherapy purposes a dose describes the amount of antigen(s) administered in a single injection from a multi-dose vial.
  • CPT codes 95115-95117 describe the professional allergenic extract administration. (Injection only)
    • CPT code 95144 describes the allergist’s preparation and provision of single-dose vials for administration by another physician.
  • CPT codes 95145-95170 represent the antigen preparation. (Preparation only)
  • CPT codes 95120-95134 describe complete service codes for the combined supply of antigen AND allergy injection provided during a SINGLE encounter. Medicare does NOT cover complete service codes. See the component-billing sample.
  • CPT code 95165 includes single OR multiple antigens.



CPT codes 95115 - 95117

    • Bill one CPT code 95115 or 95117 per date of service (DOS) and 1 unit in Box 24-G, days or units field.
    • Do NOT bill CPT code 95115 and 95117 on the same DOS.

 

  • Do NOT bill CPT code 95115 and 95117 if the antigen is self-administered by the patient.



Code 95144

  • To bill CPT code 95144, designate the number of single-dose vials prepared and provided.
  • CPT code 95144 indicates ONLY single-dose vials
  • CPT code 95144 may only be used when a physician prepares an extract to be injected by another entity.



CPT Code 95165

  • To bill CPT code 95165, designate the number of doses.
  • CPT code 95165 does NOT include antigen administration.
  • To bill for antigen preparation and administration, use component billing.(Samples below)
  • If a multi-dose vial contains less than 10cc, bill the number of 1 cc aliquots that may be removed from the vial up to a maximum of 10 doses per multi-dose vial.
  • If medically necessary, physicians may bill for preparation of more than one multi-dose vial.




CPT code 95165 Billing Exceptions

If the antigens, i.e. mold and pollen, cannot be mixed together, CGS calculates the practice expense (PE) for mixing a multi-dose vial of antigens based on the following observed practice method:

  • Physicians usually prepare a 10 cc vial and remove aliquots with a volume of 1 cc.
  • 10, 1 cc aliquot doses equal the entire PE component for the service.
  • Size or number of aliquots removed do NOT alter the PE for the service.



CPT code 95165 Billing Samples

  • To bill a 10 cc multi-dose vial filled to 6cc with antigen, submit CPT code 95165 with 6 in the days/units field.
  • If a physician removes ½ cc aliquots from a 10cc multi-dose vial for a total of 2 doses, submit CPT code 96165 with 10 in the days/unit field. (Billing for more than 10 doses represents an overpayment for the practice expense vial preparation).
  • If a physician prepares two 10cc multi-dose vials, submit CPT code 95165 with 20 in the days/unit field. (The number of aliquots removed from the vials does NOT change the number of doses billed.)



CPT codes 95144-95170 Component Billing

  • Services for CPT codes 95144-95170 represent a single dose.
  • To bill, specify number of doses in the days/units field.
  • Use a code below the venom treatment number ONLY for “catch up” purposes.
  • If a physician prepares the allergen and administers the injection on the same date of service, bill the appropriate injection code (CPT codes 95115-95117) AND the appropriate preparation code (CPT codes 95145-95170).
  • Do NOT bill CPT code 95144 AND an injection code (CPT codes 95115-95117).



CPT code 95144 Billing Samples

Sample 1:

  • Allergist bills CPT code 95144 and 2 in the days/units field to indicate preparation of 2 single-dose vials of extract.
  • Primary care bills CPT code 95117 and 1 in the days/units field to indicate the administration of 2 or more injections.



Sample 2 *Component Billing:

Allergist prepares a 10-dose vial and develops a schedule to administer one dose per encounter over a predetermined period of time.

  • Bill CPT code 95145 with 10 in the days/units field for the preparation.
  • Bill CPT code 95115 for one injection.



Sample 3

Allergist prepares a 10-dose vial and develops a schedule for the patient to self-administer the injections.

  • Bill CPT code 95145 with 10 in the days/units field for the preparation.
    • Do NOT bill an injection code.



Sample 4

Allergist prepares a 10-dose vial for non-stinging insect venom and administers one injection.

  • Bill CPT code 95165 with 10 in the days/units field for the preparation.
  • Bill CPT code 95115 for one injection.



Venom Doses and Catch-Up Billing

Since physicians prepare most venom doses in separate vials, a respective dose of CPT code 95146-95149 represents a portion of two, three, four or five venoms. Medicare built savings into the reimbursement for the higher venom codes. Therefore, if a patient receives two-venom, three-venom, four-venom or five-venom therapy, physicians should allow the highest possible venom level.

In multi-venom therapy the physician provides a portion of each venom amount. Due to patient reaction, venom administration may not remain synchronized and dosage adjustments must be made. If the physician makes an adjustment, he must synchronize the preparation to the highest-level venom as soon as possible.

Sample: A physician prepares ten doses of CPT code 95148 in two vials. One contains 10 doses of three-vespid mix and another contains 10 doses of wasp venom. Because of dose adjustment, the three-vespid mix covers 15 doses. The physician must prepare 5 doses of CPT code 95145 for the “catch-up.”

  • Bill CPT code 95148 with 10 in the days/units field for a patient in four-venom therapy.
  • Bill CPT code 95145 with 5 in the days/units field.




Treatment Boards

To report treatment boards, use the antigen preparation vial CPT codes (95145-95149, 95165 and 95170) AND the component billing method. Use CPT code 95165 in place of 95144 to bill for other than stinging/biting insects.

Sample: Allergist prepares a 10-dose vial for non-stinging allergen and administers one injection.

  • Bill CPT code 95165 with 10 in the days/units field for the preparation.
  • Bill CPT code 95115 for one injection.



CPT Code 95170

Applies ONLY to fire ant extract

Evaluation and Management (E/M) Services and Immunotherapy

To identify a significant, separately identifiable visit service above and beyond the allergen immunotherapy service provided, select the appropriate E/M code and append with Modifier 25.

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Include in the record the following information: Medical history, examination, and results of diagnostic testing (including allergy testing) upon which the need for the treatment is based.

A plan of treatment and dosage regimen must be documented in the patient’s medical record. The record should be prepared so that the data regarding injection and responses can be appreciated in a logical and sequential sense.

When an evaluation and management service is billed on the same day as allergen immunotherapy (by the same physician) a separately identifiable service must be documented in the medical record.

Documentation must support the use of the code (e.g., number of venoms, number of vials).

Documentation must be available to Medicare upon request.

 

Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS to process their claims.

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

 

 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0510 Clinic - General Classification
0517 Clinic - Family Practice Clinic
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0522 Freestanding Clinic - Home Visit by RHC/FQHC Practitioner
0523 Freestanding Clinic - Family Practice Clinic
0524 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF or Skilled Swing Bed in a Covered Part A Stay
0525 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility
0528 Freestanding Clinic - Visit by RHC/FQHC Practitioner to Other non-RHC/FQHC site (e.g. Scene of Accident)
0529 Freestanding Clinic - Other Freestanding Clinic
0982 Professional Fees - Outpatient Services
0983 Professional Fees - Clinic
N/A

CPT/HCPCS Codes

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Group 1

(12 Codes)
Group 1 Paragraph

N/A

 Group 1 Codes
Code Description
95115 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE INJECTION
95117 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 OR MORE INJECTIONS
95144 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE DOSE VIAL(S) (SPECIFY NUMBER OF VIALS)
95145 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); SINGLE STINGING INSECT VENOM
95146 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 2 SINGLE STINGING INSECT VENOMS
95147 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 3 SINGLE STINGING INSECT VENOMS
95148 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 4 SINGLE STINGING INSECT VENOMS
95149 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); 5 SINGLE STINGING INSECT VENOMS
95165 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES)
95170 PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; WHOLE BODY EXTRACT OF BITING INSECT OR OTHER ARTHROPOD (SPECIFY NUMBER OF DOSES)
95180 RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, EQUINE SERUM)
95199 UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE
N/A

CPT/HCPCS Modifiers

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(67 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

One of the following ICD-10-CM diagnosis codes is required for all CPT codes within this policy with the exception of 95170 and 95180:

Group 1 Codes
Code Description
H10.411 - H10.413 Chronic giant papillary conjunctivitis, right eye - Chronic giant papillary conjunctivitis, bilateral
H10.419 Chronic giant papillary conjunctivitis, unspecified eye
H10.45 Other chronic allergic conjunctivitis
J30.0 - J30.2 Vasomotor rhinitis - Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.998 Other asthma
J82.81 Chronic eosinophilic pneumonia
J82.82 Acute eosinophilic pneumonia
J82.83 Eosinophilic asthma
T63.421A Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.422A Toxic effect of venom of ants, intentional self-harm, initial encounter
T63.422D Toxic effect of venom of ants, intentional self-harm, subsequent encounter
T63.423A Toxic effect of venom of ants, assault, initial encounter
T63.423D Toxic effect of venom of ants, assault, subsequent encounter
T63.424A Toxic effect of venom of ants, undetermined, initial encounter
T63.424D Toxic effect of venom of ants, undetermined, subsequent encounter
T63.441A Toxic effect of venom of bees, accidental (unintentional), initial encounter
T63.441D Toxic effect of venom of bees, accidental (unintentional), subsequent encounter
T63.442A Toxic effect of venom of bees, intentional self-harm, initial encounter
T63.442D Toxic effect of venom of bees, intentional self-harm, subsequent encounter
T63.443A Toxic effect of venom of bees, assault, initial encounter
T63.443D Toxic effect of venom of bees, assault, subsequent encounter
T63.444A Toxic effect of venom of bees, undetermined, initial encounter
T63.444D Toxic effect of venom of bees, undetermined, subsequent encounter
T63.451A Toxic effect of venom of hornets, accidental (unintentional), initial encounter
T63.451D Toxic effect of venom of hornets, accidental (unintentional), subsequent encounter
T63.452A Toxic effect of venom of hornets, intentional self-harm, initial encounter
T63.452D Toxic effect of venom of hornets, intentional self-harm, subsequent encounter
T63.453A Toxic effect of venom of hornets, assault, initial encounter
T63.453D Toxic effect of venom of hornets, assault, subsequent encounter
T63.454A Toxic effect of venom of hornets, undetermined, initial encounter
T63.454D Toxic effect of venom of hornets, undetermined, subsequent encounter
T63.461A Toxic effect of venom of wasps, accidental (unintentional), initial encounter
T63.461D Toxic effect of venom of wasps, accidental (unintentional), subsequent encounter
T63.462A Toxic effect of venom of wasps, intentional self-harm, initial encounter
T63.462D Toxic effect of venom of wasps, intentional self-harm, subsequent encounter
T63.463A Toxic effect of venom of wasps, assault, initial encounter
T63.463D Toxic effect of venom of wasps, assault, subsequent encounter
T63.464A Toxic effect of venom of wasps, undetermined, initial encounter
T63.464D Toxic effect of venom of wasps, undetermined, subsequent encounter
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T78.40XA Allergy, unspecified, initial encounter
T78.49XA Other allergy, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
Z91.014 Allergy to mammalian meats
Z91.030 Bee allergy status
Z91.038 Other insect allergy status
Z91.048 Other nonmedicinal substance allergy status
Z91.09 Other allergy status, other than to drugs and biological substances

Group 2

(7 Codes)
Group 2 Paragraph

The following ICD-10-CM diagnosis code is required with CPT 95170:

T63.421A, T63.421D, T63.431A, T63.431D, and T63.481A should be used as an additional code for more detailed analysis.

 Group 2 Codes
Code Description
T63.421A Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.431A Toxic effect of venom of caterpillars, accidental (unintentional), initial encounter
T63.431D Toxic effect of venom of caterpillars, accidental (unintentional), subsequent encounter
T63.481A Toxic effect of venom of other arthropod, accidental (unintentional), initial encounter
T78.2XXA Anaphylactic shock, unspecified, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter

Group 3

(30 Codes)
Group 3 Paragraph

One of the following ICD-10-CM diagnosis codes is required with CPT 95180:

 Group 3 Codes
Code Description
T36.0X5A Adverse effect of penicillins, initial encounter
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.3X5A Adverse effect of macrolides, initial encounter
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.95XA Adverse effect of unspecified systemic antibiotic, initial encounter
T37.0X5A Adverse effect of sulfonamides, initial encounter
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.B15A Adverse effect of smallpox vaccines, initial encounter
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T80.51XA Anaphylactic reaction due to administration of blood and blood products, initial encounter
T80.52XA Anaphylactic reaction due to vaccination, initial encounter
T80.59XA Anaphylactic reaction due to other serum, initial encounter
T88.6XXA Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
Z88.0 - Z88.3 Allergy status to penicillin - Allergy status to other anti-infective agents
Z88.7 Allergy status to serum and vaccine
Z91.012 Allergy to eggs
Z91.014 Allergy to mammalian meats
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
Code Description
0510 Clinic - General Classification
0517 Clinic - Family Practice Clinic
0519 Clinic - Other Clinic
0520 Freestanding Clinic - General Classification
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0522 Freestanding Clinic - Home Visit by RHC/FQHC Practitioner
0523 Freestanding Clinic - Family Practice Clinic
0524 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF or Skilled Swing Bed in a Covered Part A Stay
0525 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not in a Covered Part A Stay) or NF or ICF MR or Other Residential Facility
0528 Freestanding Clinic - Visit by RHC/FQHC Practitioner to Other non-RHC/FQHC site (e.g. Scene of Accident)
0529 Freestanding Clinic - Other Freestanding Clinic
0982 Professional Fees - Outpatient Services
0983 Professional Fees - Clinic
N/A

Other Coding Information

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/27/2022 R8

Revision Effective: 10/27/2022
Revision Explanation: Annual Review, no changes made
10/21/2021 R7

Revision Effective: 10/21/2021
Revision Explanation: Annual Review, no changes made
10/01/2021 R6

Revision Effective: 10/01/2021
Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Groups 1 and 3 : Code added Z91.014.
10/01/2020 R5

Revision Effective: N/A
Revision Explanation: Annual Review, no changes made
10/01/2020 R4

Revision Effective: 10/01/2020
Revision Explanation: During the ICD-10 annual update J82 was deleted and replaced with J82.81-J82.83.
01/01/2020 R3

Revision Effective: 01/01/2020

Revision Explanation: Added information from old article A52528 to this one concerning definitions of allergy immunotherapy and information on specific codes in the article.
09/19/2019 R2

Revision Effective: 11/07/2019

Revision Explanation: Updated article text with other comments from Coverage Indications, Limitations and/or Medical Necessity and Associated Information based on TDL 190550. Added details from LCD L32553.
09/19/2019 R1

R1

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L32553 - Allergy Immunotherapy
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11/07/2023 11/16/2023 - N/A Currently in Effect View
10/27/2023 11/02/2023 - 11/15/2023 Superseded View
10/21/2022 10/27/2022 - 11/01/2023 Superseded You are here
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