Venom Doses and Catch-Up Billing

Since physicians prepare most venom doses in separate vials, a respective dose of CPT code 95146-95149 represents a portion of two, three, four or five venoms. Medicare built savings into the reimbursement for the higher venom codes. Therefore, if a patient receives two-venom, three-venom, four-venom or five-venom therapy, physicians should allow the highest possible venom level.

In multi-venom therapy the physician provides a portion of each venom amount. Due to patient reaction, venom administration may not remain synchronized and dosage adjustments must be made. If the physician makes an adjustment, he must synchronize the preparation to the highest-level venom as soon as possible.

Sample: A physician prepares ten doses of CPT code 95148 in two vials. One contains 10 doses of three-vespid mix and another contains 10 doses of wasp venom. Because of dose adjustment, the three-vespid mix covers 15 doses. The physician must prepare five doses of CPT code 95145 for the ‘catch-up.’

  • Bill CPT code 95148 with 10 in the days/units field for a patient in four-venom therapy
  • Bill CPT code 95145 with 5 in the days/units field

Treatment Boards To report treatment boards, use the antigen preparation vial CPT codes (95145-95149, 95165 and 95170) AND the component billing method. Use CPT code 95165 in place of 95144 to bill for other than stinging/biting insects.
Sample: Allergist prepares a 10-dose vial for non-stinging allergen and administers one injection.

  • Bill CPT code 95165 with 10 in the days/units field for the preparation.
  • Bill CPT code 95115 for one injection.

CPT Code 95170 Applies ONLY to fire ant extract

Evaluation and Management (E/M) Services and ImmunotherapyTo identify a significant, separately identifiable visit service above and beyond the allergen immunotherapy service provided, select the appropriate E/M code and append with CPT modifier 25.