Medicare recently released allergy & immunology provider compliance data for 2021, which provides interesting information for our specialty. See the tips – select “Allergy Services” as the topic.
The good news is that allergy and immunology providers are extremely compliant when billing for Medicare Part B services! According to CMS, the improper payment rate for allergy and immunology providers billing Part B is just 1.9% – with a projected improper payment amount of $13 million. This amounts to a tiny fraction (0.1%) of overall improper Medicare payments. In fact, the allergy/immunology rate of 1.9% is one of the lowest improper payment rates of all the specialties examined, with the average for all provider types at 8.5%. See CMS’ 2021 Medicare Fee-for-Service (FFS) Supplemental Improper Payment Data (pages 49-50) for specialty comparison data.
For the 2021 reporting period, insufficient documentation accounted for 63.5% of errors for allergy and immunology providers. Incorrect coding caused the remaining 36.5% of improper payments.
Medicare Local Coverage Article (LCA): Allergy Immunotherapy (A56424) has the most current HCPCS and CPT codes for our specialty. Medicare outlines other allergy-related policy requirements in Local Coverage Determination (LCD): Allergy Immunotherapy (L32553) LCA A56424, LCD: Allergy Immunotherapy (L36408) and LCA: Billing and Coding: Allergy Immunotherapy (A57472).
