Posted in #aetna, Training, Updates

AETNA: Allergy Testing Update- 06/01/21

As per Aetna March Bulletin– when the provider is going to perform/bill allergy testing codes (95004-95079) with the code 95180 (rapid desensitization); AETNA will deny allergy testing and consider it mutually exclusive to rapid desensitization.

This change will become affective as of 06/01/2021

Allergy Skin Prick Testing (95004)

In order to not get this type of denial, providers will have to do allergy testing (95004-95079) on a separate date as a rapid desensitization (95180).

Example Billing:

DOS 1: 99204-25, 95004 (40)-59, 95012-59

DOS 2: 99213-25, 95180 (Q)

#Aetna, #allergy, #allergytesting, #environmental, #food

Posted in Training, Updates

Alert: UHC Community Health NY- allergy testing changes 05/01/2021

As per UHC Community Health NY bulletin- the following changes will take place, effective 05/01/2021 for allergy testing codes:

The frequency (Medically Unlikely Units Policy) will reflect the policy enhancements over 5-year period, in accordance with NY State Policy Requirements.

**If you ever watched my BC Advantage presentation on Allergy Tests (2020) – please update your records. Note: I always state that you should check the policies discussed in all of my webinars/presentations at least 6 months after you watch them.

What does this mean for the provider?

If the provider will bill over the maximum allowed amount for each of above listed code, those “extra” units will be denied.

#allergytesting, #UHCcommunityhealth, #invitro, #intradermal, #penicilintesting

Posted in In The Know Series, My services, Training, Updates

Empire NYSHIP Plans and member cost-sharing for diagnostic allergy and asthma testing: year 2020 and beyond

This post is for Allergy & Asthma providers that accept Empire NYSHIP (TPA UHC) patients and perform diagnostic asthma/allergy testing in the office setting (POS 11).

Commonly used CPT codes in Office Setting (w/ short description)

1. 95004- skin prick allergy testing

2. 95024- intradermal allergy testing

3. 95044- patch allergy testing

4.95018- Medication (Penicillin) allergy testing

5. 94200- Peak flow

6. 95012- NIOX or FENO

Member cost-sharing/patient co-pays for year 2020 and beyond:

Most of the Empire NYSHIP plans (there are various types), have updated their co-pay to $25 per office visit (specialist) Please click here to visit my post on the updated Empire NYSHIP co-pays.

However, as recent as last year, the Empire NYSHIP plans also started to add, an extra $25 member cost-sharing fee, to the above mentioned CPT codes. In order for your office not to leave this uncollected revenue on the table, please make sure to inform your front office staff of this change!  

Now  let’s take a look at 2 (TWO) examples.

Ex. 1. Patient comes in for the first time and has the environmental skin prick testing done the same day. The billing would be:  99204 25 with 95004X40 -the total patient financial responsibility would be $50: $25 for OV and $25 for testing.

Ex. 2. Patient with DX of Allergic Asthma (J45.30) is coming in for a follow up visit. The billing would be: 99213 25 with 94200 59 and 95012 59. In this instance the second co-pay would be applied to 94200 and 95012 would be paid. So, the patient will still pay only $50 co-pay.

Now, If you have any more questions about this post, Empire NYSHIP patients cost-sharing or something else, please go on my (SERVICES) page and contact me for a free 30-min Evaluation ($250 Value).