CPT code 95125 is used to describe the administration of two or more injections for immunotherapy treatments.
CPT code 95125 is used to describe a procedure involving immunotherapy where two or more injections are administered. Immunotherapy is a treatment designed to enhance or suppress the immune system to help the body fight diseases, such as allergies or certain types of cancer. This specific code indicates that the patient received multiple injections during a single visit, which is a common practice in allergy treatments where multiple allergens are introduced to build up the body's tolerance. This code is essential for healthcare providers to accurately document and bill for the services rendered during immunotherapy sessions.
For CPT code 95125, which involves immunotherapy with two or more injections, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. This modifier is used if a significant, separate E/M service is provided in addition to the immunotherapy.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the immunotherapy service is distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. This modifier is used if the same procedure is repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the procedure is repeated on the same day by a different provider.
5. Modifier 91: Repeat clinical diagnostic laboratory test. Although not typically used for immunotherapy, this modifier might be relevant if the procedure involves repeated testing as part of the service.
6. Modifier 95: Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system. This modifier is used if the immunotherapy service is provided through telemedicine.
Each of these modifiers serves a specific purpose and should be used in accordance with the specific circumstances of the service provided. Proper use of modifiers ensures accurate billing and reimbursement.
CPT code 95125 is reimbursed by Medicare, but the reimbursement is subject to specific conditions and guidelines outlined in the Medicare Physician Fee Schedule (MPFS). The MPFS provides a comprehensive list of services covered by Medicare, along with the associated payment rates. However, the actual reimbursement for CPT code 95125 can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC has the authority to interpret national policies and set local coverage determinations, which can influence whether and how a particular service is reimbursed. Therefore, healthcare providers should consult their specific MAC for detailed information on the reimbursement criteria and rates for CPT code 95125.
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