Key takeaways Allergy testing and immunotherapy use separate, non-interchangeable CPT code sets. Billing the wrong code combination triggers denials regardless of medical necessity. Immunotherapy dose miscounting is one of the most common sources of underpayment. Medicare does not cover complete-service immunotherapy codes; component billing is required. Modifier 25 has specific, narrow rules for same-day E/M […]
Navigating the Wild West of Allergy and Immunology Billing
Key takeaways Allergy and immunology billing involves complex coding, payer variability, and documentation standards that change frequently. Practices often experience denials or delayed payments even when care is delivered correctly and consistently. Payer rules around allergy testing and immunotherapy are a common source of revenue leakage. Working with a billing partner that understands allergy and […]
Medicare Increases Scrutiny of Billing E/M Services With Allergy Testing or Allergy Immunotherapy
Medicare is paying closer attention to organizations that bill evaluation and management codes reported with allergy testing or allergy immunotherapy. This is according to a recent issue of Medicare Quarterly Provider Compliance Newsletter (pdf), a newsletter from CMS developed to help providers understand the major findings identified by Medicare administrative contractors, recovery auditors and other […]
New Case Study: Allergy Practice Outsources Medical Billing to PGM Billing
A new case study is now available for download in our Library. The case study details the experience of A2 Medical Group, a multi-office allergy practice, that outsourced its medical billing to PGM Billing to help overcome challenges such as high days in accounts receivable (A/R), poor coding and inadequate A/R follow up. Hear from […]