T37.2X6A — Underdosing of antimalarials and drugs acting on other blood protozoa, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim.
- The diagnosis code(s) submitted must accurately and specifically describe the patient's condition for which the visual electrophysiology test was performed.
- Follow applicable NCCI and OPPS billing requirements and edits prior to claim submission as coding may be affected by these edits.
- When E/M services are reported with allergy testing, medical documentation of the separately identifiable E/M service must be present in the medical record and modifier -25 must be used.
Key Coverage Criteria
- Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
- Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
- Standard skin testing is the preferred method when allergy testing is necessary.
- When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
- CPT code 95060 is payable in office, outpatient hospital (on-campus/off-campus), inpatient hospital, and emergency room settings.
- Allergy skin testing is covered when performed after a complete medical and immunologic history and an appropriate face-to-face physical examination.
9 Active Policies
L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
L37015 — Visual Electrophysiology Testing
J05
A57472 — Billing and Coding: Allergy Immunotherapy
J05
A57473 — Billing and Coding: Allergy Testing
J05
A57599 — Billing and Coding: Visual Electrophysiology Testing
Related Codes
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