Does 95170 require prior authorization?

No, 95170 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 95170?

Medicare facility rate: $2.67. Non-facility rate: $10.69. Work RVU: 0.06.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.06

Facility

$2.67

Non-Facility

$10.69

Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the medical record must be legible and include patient identification information (e.g., full name, dates of service).
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) used for billing.

Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L36240.
Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L37800.
Allergen immunotherapy administered in a home setting is allowable if documentation demonstrates that the benefits of home administration outweigh the risks and includes the patient's informed consent and validation of the administrator's training to recognize and manage immunotherapy reactions (including anaphylaxis).
Allergen immunotherapy is defined as the repeated administration of specific allergens to patients with IgE-mediated conditions, for the purpose of providing protection against the allergic symptoms and inflammatory reactions associated with natural exposure to these allergens.
Controlled studies have shown that allergen immunotherapy is effective for patients with allergic rhinitis or conjunctivitis, allergic asthma, and stinging insect hypersensitivity.
Allergen immunotherapy is indicated for patients who show demonstrable evidence of specific IgE antibodies to clinically relevant allergens and whose allergic symptoms warrant the time and risk of allergen immunotherapy.

A57472 — Billing and Coding: Allergy Immunotherapy

J05

L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

A57678 — Billing and Coding: Allergen Immunotherapy

J09

L37800

Ask Verity about documentation requirements, denial risks, or coverage in your state.