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November 2016

We’ve made some changes to our allergy antigens policy

Our allergy antigens policy has been updated since we communicated about it in the March 2016 Record. Please refer to the information that follows for details on our allergy antigens policy.

When billing procedure code *95165 for allergy antigens preparations, health care providers are required to specify the number of anticipated doses to prepare as units.

A dose, or unit, won’t be defined as one cubic centimeter. It will be defined as the amount of serum injected into the patient at the time of treatment.

Procedure code *95165 should be billed on a separate line for each multi-dose vial prepared with the number of anticipated doses at the time of preparation.

Providers may bill for:

  • Preparation of a reasonable supply of allergy antigen at one time
  • No more than a 12-month supply
  • Unused prepared antigen left over after the patient begins treatment

Patients may ask that the antigen is mixed in preparation of immunotherapy. However, if the patient doesn’t begin the treatment, the patient is responsible for the cost of the preparation and provision of the antigen.

Patients should be notified of any potential liability at the time they request treatment. Providers should use the Advance Notice of Member Responsibility form to document that they have informed patients of this potential liability.

To sum up, Blue Cross shouldn’t be billed for an antigen that isn’t administered to the patient.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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