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Allergen Specific Immunotherapy

Dec. 21, 2016

Effective July 1, 2016, Blue Cross Blue Shield of Montana (BCBSMT) updated the ClaimsXten Medically Unlike Edit (MUE) rule logic for Current Procedural Terminology (CPT) code 95165 with the third quarter update on September 19, 2016. Based on Center for Medicare & Medicaid Services (CMS) the per day billable units is 30 per day.  After further consideration, BCBSMT has determined that based on Medical Policy we will modify the MUE rule to align with the Medical Policy.  At this time, BCBSMT will continue to allow services per CPT billing guidelines and the Allergy Management Medical Policy for the prospectively planned supply of the antigen at the beginning of the scheduled treatment, reporting the number of doses prepared and provided.  Claims with a date of service of July 1, 2016 and after will be adjusted.