Você está na página 1de 3

Chapter 1: Allergen Immunotherapy

Immunotherapy is the periodic administration of allergenic extracts. A physician determines the necessity of
immunotherapy as a result of allergy testing (see separate section) and patient history.
For these services, you'll most likely use the following codes:

95115 Professional services for allergen immunotherapy not including provision of allergenic extracts; single
95117 ... two or more injections
95120 Professional services for allergen immunotherapy in the office or institution of the prescribing physician or
other qualified health care professional, including provision of allergenic extract; single injection
95125 ... two or more injections
95130 ... single stinging insect venom
95131 two stinging insect venoms
95132 ... three stinging insect venoms
95133 ... four stinging insect venoms
95134 ... five stinging insect venoms
95144 Professional services for the supervision of preparation and provision of antigens for allergen
immunotherapy, single does vial(s) (specify number of vials)
95145 Professional services for the supervision of preparation and provision of antigens for allergen
immunotherapy (specify number of doses); single stinging insect venom
95146 ... two single stinging insect venoms
95147 ... three single stinging insect venoms
95148 ... four single stinging insect venoms
95149 ... five single stinging insect venoms
95165 Professional services for the supervision of preparation and provision of antigens for allergen
immunotherapy; single or multiple antigens (specify number of doses)
95170 ... whole body extract of biting insect or other arthropod (specify number of doses)
95180 Rapid desensitization procedure, each hour (e.g., insulin, penicillin, equine serum)
95199 Unlisted allergy/clinical immunologic service or procedure.

Report Allergy Shots as 95115, 95117

When a physician provides an allergy injection without mixing the serum, you should assign 95115 or 95117. These
two codes are for the injection services and do not include providing the extract.
Example 1: A patient's allergist sends you vials to use for immunotherapy, and you perform the injections. Choose
95115 or 95117 based on the number of injections the patient receives. To indicate that the patient received one
allergen injection, use 95115. Code 95117 indicates the patient received two or more allergen injections.
Be careful: Always report allergen immunotherapy codes 95115 or 95117 one time, regardless of the number of
injections performed. You should not specify each injection. Injections for allergen immunotherapy differ from other
injections because you only bill for the number of injections, not for the substance injected.
Pitfall: When reporting either of these codes, you may only enter a unit of "1" on the claim sheet. Code 95117 covers
any number of shots beyond one, so you only need report it once.

CPT 2014 American Medical Association. All rights reserved.

Codes 95115-95199 include professional services. Report office visit codes (99201-99215) only if the physician
provides other services in addition to allergen immunotherapy.
Capture Injections and Extract with 95120-95125
When the physician uses a treatment board to mix each serum prior to administration, you should use 95120 or 95125.
Example 2: A physician prescribes allergy immunotherapy for a young patient. On the child's bimonthly therapy day,
a nurse mixes the serum and gives the injections. In this case, you should report 95120 or 95125 to describe allergen
immunotherapy including allergenic extract provision. Codes 95120-95125 and 95115-95117 parallel each other in
terms of quantity. Use 95120 as you do 95115 for a single injection. When a patient receives two or more injections
with extract provision, report 95125.
Watch out: Practices typically report the injection service codes rather than the combination injection and serum
codes. Usually the allergist's office will mix the serum, and the physician would administer the injections. In fact, many
carriers do not cover combination serum mixing and allergen immunotherapy codes. Because 95120-95125 describe
single- dose preparation and administration, they are rarely used. Physicians find it easier to mix serum in multi-use
vials than individually off treatment boards.
Code Multi-Dose Prep With 95165
When a staff member makes multi-dose vials, you should separately code the preparation and administration. Bill for
the serum with 95165 on the day the staff prepare the vials provided a physician has been on premises to supervise its
preparation. Then, report 95115 or 95117 when the patient receives the injections.
Example 3: A physician prepares a 10-dose vial for a patient. The next week, a nurse administers one injection to the
patient containing one dose from the vial. For the antigen preparation and provision, you should report 95165 with the
number of doses. On the injection day, assign 95115. CPT defines a clinical dose as the amount of antigens administered in a single injection from a multiple-dose vial. Because the vial in Example 3 contains 10 doses, you should
report 95165 with a "10" in the "units" box.
Focus on Antigen Number for Venom Shot
Coding for stinging insect venom (95145-95149, 95170) is slightly different from coding for administration of other
Example: If your pediatrician prepares five doses of an antigen containing two stinging-insect venoms, you should use
95146 x 5 and 95117 for the administration of each dose at each encounter. Use these codes regardless of whether
the doses come from the same multiple-dose vial or a series of vials because the code describes the dose, not the
bottle. The main problem you have when reporting stinging insect venom codes is that you must be aware of the
number of venoms your physician administers. When you bill for venoms, the number of insects and the number of
doses are important. This is different from the allergen antigens, in which how many antigens the vial contains is
irrelevant. CPT states that these codes do not include the antigen administration.
Go With Allergen Trigger for Diagnosis
Patients receive allergen immunotherapy injections because of a known allergy. So you should often use diagnosis
codes 477.0-477.8 (Allergenic rhinitis ). Practices that use V07.2 (Prophylactic immunotherapy) for the diagnosis
code may face denials.
Check with your major insurers for other accepted ICD-9 codes. Some plans may follow Medicares lead and accept
additional diagnoses, such as:

372.14 Other chronic allergic conjunctivitis

493.90-493.92 Asthma, unspecified

CPT 2014 American Medical Association. All rights reserved.

518.3 Pulmonary eosinophilia

995.0 Other anaphylactic reaction
995.3 Allergy, unspecified
V15.0x Personal history of allergy, other than to medicinal agents.

Allergen Immunotherapy + E/M = OK

When you report an office visit and same-day immunotherapy, CPT does not require you to use modifier 25.
Medicare allows an office visit and injection on the same day without modifier 25.
Example: A physician sees a patient due to nasal congestion (478.19), and then the patient receives her scheduled
bimonthly series of two allergy injections for allergic rhinitis due to pollen (477.0). The physician performs and
documents a level-two E/M service. You may report 99212 and 95117, according to Medicare rules.
Billing 99212 or any other E/M service with 95115 or 95117 is a recent turn of events. Prior to Jan. 1, 2006, Medicare
designated allergy injections as global-period codes. The designation meant you could not bill 95115 and 95117 with
an E/M service without using modifier 25.
Under Medicare policy, 95115 and 95117 have no global periods. You can bill an E/M service (including 99211) with
allergy injection codes without meeting the requirements for modifier 25. Because 95115 and 95117 include no
payment for physician work, payment of a separate E/M service is appropriate.
You can even report a minimal E/M service related to immunotherapy. Providers may bill for a nurse-only 99211 when
dealing with clinical issues surrounding allergy injection administration. The service could represent directing a nurse
who gives injections on what to do if a patient:

Was ill
Missed an injection
Had a large, local reaction or mild unreported systemic symptoms after his last injection.

Be careful: On claims involving a nurse visit related to allergy immunotherapy, don't append modifier 25 to 99211.
When you bill 99211 for providing clinical advice related to the injection, modifier 25 is unnecessary and does not
apply. But the nurse must document the medically necessary E/M service that she provided.

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.