Novitas Solutions – the Medicare administrative contractor (MAC) for Texas – confirmed to the Texas Medical Association that physicians can and should receive payment for the “buildup phase” of allergen immunotherapy injections, or allergy shots, after Texas physicians reported concerns.
The news came during a meeting with TMA payment specialists, when Novitas Chief Medical Director Anita Graves, MD, clarified payment is available for the buildup phase of allergy shots (updosing), induction, and the dose-increase phase. Members of the American College of Asthma, Allergy and Immunology (ACAAI) had asked TMA for assistance confirming that local MACs would pay for updosing.
“We could have wasted countless hours pursuing this effort without the assistance of TMA. Partnerships like this one are the foundation of effective advocacy,” said J. Allen Meadows, MD, ACAAI’s executive director of advocacy and government affairs.
ACAAI has received written confirmation of this policy from Novitas. TMA continues to meet with Novitas to ensure physicians do receive such payment and asks members to contact the association’s Physician Payment Resource Center (PPRC) if claims denials occur.
Vivek Rao, MD, an Odessa allergist and member of TMA’s Council on Legislation, says billing guidance from national allergy societies and Medicare carriers have historically remained inconsistent – making TMA’s work to clarify physicians’ payment complexities “extremely helpful.”
“For a number of years, it was unclear whether Medicare would allow buildup doses and, for that reason, national allergy societies recommended physicians instead bill only for the maintenance phase,” when patients receive shots less often, said Dr. Rao, a member of ACAAI.
“You never know when an issue [will] come along that requires help from a 59,000-member organization that has connections and influence that a specialty society may lack. That’s why I encourage all of my allergy and immunology colleagues to join TMA.”
Per CMS, both initial and maintenance allergy dosage phases must be individualized for each patient. Documentation of both stages should include the initial concentration, any changes or delays of progress and the reasoning for such, and the target concentration.
For more information and documentation assistance, visit TMA’s PPRC.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469