How To Use CPT Code 95065

CPT 95065 describes the direct nasal mucous membrane test, which is a procedure used to test for allergic reactions in the nasal cavity. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95065?

CPT 95065 is a code used to describe the direct nasal mucous membrane test. This test is performed by a healthcare provider to check for any significant allergic reactions in the inner lining of the patient’s nasal cavity. It involves introducing an allergenic extract into the nose to determine the allergens that may be causing a reaction and the degree of the reaction. It provides valuable data on changes in nasal airway resistance.

2. Official Description

The official description of CPT code 95065 is: ‘The provider tests the patient’s nasal mucus membrane, which is the moist inner lining of the nose, for any allergic reactions. Providers commonly perform allergy testing to determine the allergens that cause a particular reaction and the degree of the reaction. This code represents the technical component of the service only.’

3. Procedure

1. The healthcare provider begins by examining the patient’s nasal cavity to ensure it is suitable for the test.
2. An allergenic extract, which is a protein containing an extract purified from a substance to which the patient may be allergic, is introduced into the inner lining of the nose.
3. The provider carefully observes the patient’s nasal mucus membrane for any allergic reactions, such as redness, swelling, or other signs of irritation.
4. The provider records any significant allergic reactions and assesses the degree of the reaction.
5. The test provides valuable data on changes in nasal airway resistance, which can help in diagnosing and managing allergies.

4. Qualifying circumstances

The direct nasal mucous membrane test, represented by CPT code 95065, is performed on patients who may be experiencing allergic reactions in their nasal cavity. This test is commonly used to determine the allergens that cause a particular reaction and the severity of the reaction. It is important to note that CPT code 95065 represents the technical component of the service only, and modifiers 26 or TC should not be appended to this code.

5. When to use CPT code 95065

CPT code 95065 should be used when a healthcare provider performs the direct nasal mucous membrane test to check for allergic reactions in the patient’s nasal cavity. This code represents the technical component of the service only and should not be reported with modifiers 26 or TC.

6. Documentation requirements

To support a claim for CPT code 95065, the healthcare provider must document the following information:

• Patient’s symptoms or complaints related to nasal allergies
• Details of the direct nasal mucous membrane test performed
• Results of the test, including any significant allergic reactions observed
• Assessment of the degree of the allergic reaction
• Any additional relevant information related to the test

7. Billing guidelines

When billing for CPT code 95065, it is important to remember that this code represents the technical component of the service only. Modifiers 26 or TC should not be appended to this code. It is also important to review the specific billing guidelines provided by the payer to ensure accurate and appropriate reimbursement.

8. Historical information

CPT code 95065 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs a direct nasal mucous membrane test on a patient who presents with symptoms of nasal allergies. The test reveals a significant allergic reaction to a specific allergen.
2. During the direct nasal mucous membrane test, the healthcare provider introduces an allergenic extract into the patient’s nasal cavity and observes no allergic reactions.
3. A patient undergoes a direct nasal mucous membrane test, and the healthcare provider identifies multiple allergens causing significant allergic reactions in the nasal cavity.
4. After performing a direct nasal mucous membrane test, the healthcare provider determines that the patient’s nasal cavity shows no signs of allergic reactions.
5. During the direct nasal mucous membrane test, the healthcare provider identifies a mild allergic reaction in the patient’s nasal cavity to a specific allergen.
6. A patient undergoes a direct nasal mucous membrane test, and the healthcare provider observes severe allergic reactions in the nasal cavity to multiple allergens.
7. After performing a direct nasal mucous membrane test, the healthcare provider concludes that the patient’s nasal cavity exhibits moderate allergic reactions to a specific allergen.
8. During the direct nasal mucous membrane test, the healthcare provider introduces an allergenic extract into the patient’s nasal cavity and observes a mild allergic reaction.
9. A patient undergoes a direct nasal mucous membrane test, and the healthcare provider identifies no allergic reactions in the nasal cavity.
10. After performing a direct nasal mucous membrane test, the healthcare provider determines that the patient’s nasal cavity shows significant allergic reactions to multiple allergens.