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PATCH TESTING CODING AND REIMBURSEMENT GUIDE

  The information provided below is believed to be current and correct as of August 1, 2014. It is intended to be used only as a guide to the steps required for billing patch testing services rendered by a physician.

Users should always consult state or federal regulations for guidance about changes in coding and reimbursement.
   
       
  CODING FOR EVALUATION AND MANAGEMENT (E/M) SERVICES    
       
 
NEW PATIENTS
   
 
CPT Code HISTORY PHYSICAL EXAM TIME (Min)
99201 Problem-focused Problem-focused 10
99202 Expanded problem- focused Expanded problem- focused 20
99203 Detailed Detailed 30
99204* Comprehensive Comprehensive 45
99205* Comprehensive Comprehensive 60
       
   
  *These codes are should not be used by service providers as they require extensive documentation for levels of care rarely performed or necessary.    
       
 
RETURN VISIT PATIENTS
   
 
CPT Code HISTORY PHYSICAL EXAM TIME (Min)
99211 Problem-focused Problem-focused 5
99212 Expanded problem- focused Expanded problem- focused 10
99213 Detailed Detailed 15
99214* Comprehensive Comprehensive 25
99215* Comprehensive Comprehensive 40
       
   
  *These codes are should not be used by service providers as they require extensive documentation for levels of care rarely performed or necessary.    
       
  Additionally, use CPT code 95044 (or 95052 for Photo Patch) for each patch test application. Specify the number of tests in field 24G of CMS form 1500. For example if you used North American Extended series (65 haptens) 65 is the multiplier used for the 95044 reimbursement fee.    
       
       
       
 
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