MVP- Allergy reimbursement policy- updated

For any NY/VP providers that offer allergy services- this blog post is for you!

In the recent years, I have noticed that various payers started to update their Allergy procedure policies- medical and reimbursement.

MVP is no exception- this policy has been updated for any DOS 2/1/2025 and thereafter.

The policy covers common testing and immunotherapy treatment.

What to look for?

For these type of policies it is essential that the providers double check the max allowed of units for these services- this will prevent unecessary claim denials and reduction in the revenue of your practice!

Testing:

  • 95004- percutaneous (scratch, puncture, and prick) allergy testing with an immediate reaction and a test interpretation report- max of 80 units per calendar year.
  • 95024- intracuteneous allergy testing – usually used for food allergy testing- max of 40 units per calendar year
  • 95027-Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests- max of 40 unites per calendar year
  • 95028-Intracutaneous allergy testing, delayed reaction- used for drug or contact dermatitis testing- allowed 30 units per calendar year.

Specialties:

  • Allergist
  • Dermatologist

Serum- immunotherapy services:

  • 95165- Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens. –First year- is limited to 40 units/doses per claim and 160 units/doses per calendar year. Subsequent years- allowed max 30 units per claim, 120 units per calendar year.

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