billing CPT 95115,95120 – Coding tips for allergen immunotherapy – 95165

Jul 24, 2010 | Medical billing basics

Medicare Regulations and Coding Guidelines for Allergen Immunotherapy 
  1. Codes 95115-95117 describes the professional service for the injection of the antigen but does not include the supply of the antigen.
  2. Codes 95120-95134 describes complete service codes representing the combined preparation and supply of antigen for allergy immunotherapy in addition to the allergy injection provided. Medicare does not use these codes for payment purposes.
  3. Codes 95144-95170 are for the preparation and provision of a single dose of antigen (see below for multiple dose vials code 95165). The reimbursement amounts for the antigen codes are for a single dose. The provider should specify the number of doses provided in the units field.
  • Code 95144 describes the allergist’s preparation of single-dose vial(s) of antigens to be administered by another physician. A single-dose vial contains one dose of antigen that is administered in one injection.2 The vials are intended for use only when there is concern about accuracy of measurement doses from a multi-dose vial by a nonallergist office.The number of single-dose vials prepared and provided should be specified when reporting this code.
Example: Use of Code 95144
An individual’s allergist prepares two single-dose vials of allergenic extract for a patient who plans to travel to another city within the state during the time the injections are due. The patient receives the two allergy injections from the single-dose vial from a primary care physician.
The allergist reports code 95144 with the unit number of 2 specifying the number of vials prepared and provided.
The primary care physician reports code 95117 with the unit number of 1 indicating that two or more injections were administered at that visit.
  • Code 95165 describes the allergist’s preparation of single or multiple-dose vials of non-venom antigens to be administered by another physician. A dose is the amount of antigen(s) administered in a single injection from a multiple dose vial.2 Some non-venom antigens can not be mixed together. Common practice for mixing a multi-dose vial of antigens is to prepare a 10cc vial and then remove 1cc doses. Medicare considers a standard dose to be 1cc. Despite the number of 1cc doses removed from the vial, the reimbursement will be according to the preparation for a 10cc vial. A provider should not bill the vial preparation code for more than 10 doses per vial.
Example: Use of code 95165
If a physician uses 1/2 cc doses from a 10cc multiple-dose vial for a total of 20 doses, they should bill for no more than 10 doses.
If a physician prepares two 10cc multi-dose vials and uses 1/2cc from one vial, and 1cc from the other vial, they should bill for no more than 20 doses.
  • Codes 95145-95149 and 95170 are used to report the allergist’s preparation of stinging insect venoms. Venom doses are prepared in separate vials and not mixed together- except in the case of the three vespid mix (white and yellow hornets and yellow jackets).
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