Allergen Immunotherapy Coding Guidelines – Palmetto GBA Medicare
  • For allergen immunotherapy purposes a dose describes the amount of antigen(s) administered in a single injection from a multi-dose vial
  • CPT codes 95115-95117 describe the professional allergenic extract administration. (Injection only) CPT code 95144 describes the allergist’s preparation and provision of single-dose vials for administration by another physician
  • CPT codes 95145-95170 represent the antigen preparation (preparation only)
  • CPT codes 95120-95134 describe complete service codes for the combined supply of antigen and allergy injection provided during a single encounter. Medicare does not cover complete service codes. See the component-billing sample.
  • CPT code 95165 includes single or multiple antigens
CPT codes 95115 – 95117
  • Bill one CPT code 95115 or 95117 per date of service (DOS) and 1 unit in Box 24-G, days or units field
  • Do not bill CPT code 95115 and 95117 on the same DOS
  • Do not bill CPT code 95115 and 95117 if the antigen is self-administered by the patient
Code 95144
  • To bill CPT code 95144, designate the number of single-dose vials prepared and provided
  • CPT code 95144 indicates only single-dose vials
  • CPT code 95144 may only be used when a physician prepares an extract to be injected by another entity
CPT Code 95165
  • To bill CPT code 95165, designate the number of doses
  • CPT code 95165 does not include antigen administration
  • To bill for antigen preparation and administration, use component billing (samples below)
  • If a multi-dose vial contains less than 10 cc, bill the number of 1 cc aliquots that may be removed from the vial up to a maximum of 10 doses per multi-dose vial
  • If medically necessary, physicians may bill for preparation of more than one multi-dose vial