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PATCH TESTING CODING AND REIMBURSEMENT GUIDE
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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.
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CODING FOR EVALUATION AND MANAGEMENT (E/M) SERVICES |
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NEW PATIENTS
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CPT Code |
HISTORY |
PHYSICAL EXAM
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TIME (Min)
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99201 |
Problem-focused |
Problem-focused |
10 |
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99202 |
Expanded problem- focused |
Expanded problem- focused |
20 |
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99203 |
Detailed |
Detailed |
30 |
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99204* |
Comprehensive |
Comprehensive |
45 |
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99205* |
Comprehensive |
Comprehensive |
60 |
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*These codes are should not be used by service providers as they require
extensive documentation for levels of care rarely performed or necessary. |
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RETURN VISIT PATIENTS |
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CPT Code |
HISTORY |
PHYSICAL EXAM
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TIME (Min)
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99211 |
Problem-focused |
Problem-focused |
5 |
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99212 |
Expanded problem- focused |
Expanded problem- focused |
10 |
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99213 |
Detailed |
Detailed |
15 |
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99214* |
Comprehensive |
Comprehensive |
25 |
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99215* |
Comprehensive |
Comprehensive |
40 |
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*These codes are should not be used by service providers as they require
extensive documentation for levels of care rarely performed or necessary. |
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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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