Billing and coding guideline for – Allergen immunotheraphy

Allergy injection codes and E/M codes should not be filed for the same day unless the E/M is separately identifiable. If the E/M is separately identifiable, append modifier -25 to the office visit.

Code 96372 does not include injections for allergen immunotherapy. For allergen immunotherapy injections, use 95115-95117).

If a patient’s doses are adjusted, due to a reaction, and the antigen provided is actually more or less doses than originally anticipated, no changes should be made in the number of doses to be billed. Report the number of doses actually anticipated at the time of the antigen preparation for both venom and non-venom antigen codes.

Regardless of whether a provider uses or files for a single dose vial (95144) or multiple dose vials (95165) and are billing for the administration of the injection at the same time (95115 or 95117) they will be reimbursed at the multiple dose vial rate of CPT code 95165.

Medicare considers a reasonable supply of antigens to be not more than a 12-month supply of antigens that has been prepared for a particular patient at any one time. The purpose of the reasonable supply limitation is to assure that the antigens retain their potency and effectiveness over the period in which they are to be administered to the patient. 

The following CPT codes are covered for all product lines for the administration of the antigen(s):

95115 95117

The following CPT codes are covered for all product lines for the preparation and supply of the antigen:

95144
95145
95146
95147
95148
95165
95170

The following CPT codes are considered not separately reimbursed for all product lines. The appropriate CPT codes above should be used.

95120
95125
95130
95131
95132
95133
95134