Billing and Coding Guidelines for Allergen Immunotherapy

Allergen immunotherapy is a clinically proven treatment for reducing allergic symptoms by gradually increasing exposure to specific allergens. Accurate billing and coding are essential to ensure proper reimbursement, maintain compliance, and support continuity of care. Clear documentation, correct code selection, and adherence to payer-specific rules help prevent claim denials. This guideline provides a structured reference for healthcare providers and billing professionals to apply best practices in coding and reimbursement for allergen immunotherapy services.

Billing Guidelines for Allergen Immunotherapy

This section provides detailed instructions for selecting the correct code, calculating the dose, and following billing procedures for allergen immunotherapy services.

CPT Code 95165 – Multi-Dose Vial Preparation

• A dose of CPT code 95165 is defined as a one (1) cc aliquot from a single multi-dose vial.
• When billing code 95165, providers should report the number of units, which represents the number of 1 cc doses being prepared.
• A maximum of 10 doses per vial is allowed for Medicare billing, even if more than ten preparations are obtained from the vial.
• In cases where a multi-dose vial is diluted, Medicare should not be billed for diluted preparations over the 10 doses per vial allowed under code 95165.

CPT Procedure Codes 95145–95149 and 95170 – Stinging Insect Venoms

• These codes are used to report stinging insect venoms.
• Venom doses are prepared in separate vials and not mixed, except in the case of the three vespid mix (white and yellow hornets and yellow jackets).
• Use the code within the range that is appropriate to the number of venoms provided.
• If a code for more than one venom is reported, some amount of each of the venoms must be provided.
• Use of a code below the venom treatment number for the particular patient should occur only for ‘catching up.’

Catch-Up Doses for Venom Regimen

• When a venom regimen requires antigens to be mixed from more than one vial for administration, and one vial is depleted before the other due to a dose adjustment:
  • The physician may bill for ‘catch-up’ doses of the short antigen.
  • This must be done to synchronize the preparation back to the highest venom code possible in the shortest time.
  • To catch up, the physician would bill only the amount of the depleted vial needed to match the other vials.
  • This allows a return to preparing the full number of venoms at one time and billing the doses at higher venom codes.
  • Use of a code below the venom treatment number should occur only for ‘catching up.’

Antigen Codes (95144–95170)

• These are considered single-dose codes.
• To report these codes, specify the number of doses provided.

Dose Adjustments and Billing

• If a patient’s doses are adjusted (e.g., due to a reaction), and the antigen provided is more or fewer doses than initially anticipated, do not change the number of doses billed.
• Report the number of doses anticipated at the time of the antigen preparation.
• These instructions apply to both venom and non-venom antigen codes.
• The physician should not change the number of doses billed, even if doses are adjusted during treatment.
• If the patient receives more doses than planned (due to a decreased antigen amount per dose) or fewer doses (due to an increased antigen amount per dose), no change should be made to the billing.

Coding Guidelines for Allergen Immunotherapy

This section outlines the correct CPT code selection, reporting rules, and documentation requirements for allergen immunotherapy services.

Use of Component Codes

• Always use the component codes (95115, 95117, 95144–95170) when reporting allergy immunotherapy services to Medicare.
• Report the injection-only codes (95115 and 95117) and/or the codes representing antigens and their preparation (95144–95170).
• Avoid using the complete service codes (95120–95134).

Reporting Injection-Only Services

• Use CPT code 95115 (single injection) and 95117 (multiple injections) to report the allergy injection alone, without the provision of the antigen.

Reporting Antigen Preparation Only

• Use CPT codes 95144–95170 (provision of antigens) to report the antigen/antigen preparation service when this is the only service rendered by the physician.

Reporting Injection and Antigen Together

• Use CPT codes 95115/95117 and the appropriate CPT procedure code from the range 95145–95170 when reporting both the injection and the antigen/antigen preparation service (complete service).
• These instructions also apply to allergists who provide both services through the use of treatment boards.

Coding Based on Antigen Type

• The provision of antigens must be coded based on the specific type of antigen provided.
• CPT code 95144 is used to report regular antigens, except those from stinging insects.
• Use this code to report single-dose vials and only when the allergist prepares the extract.
• Code 95144 should be reported only if the physician providing the antigen intends to have it injected by someone other than themselves.
• If this code is reported in error in conjunction with an injection (95115 or 95117), payment will be made under code 95165.

Rapid Desensitization

• Use CPT code 95180 (rapid desensitization) when sensitivity to a drug has been established and treatment with the drug is essential.
• This procedure will also require frequent monitoring and skin testing.
• The number of hours involved in desensitization must be reported in the unit field.

Coding for Visits Without Immunotherapy

• A visit to an allergist that yields a diagnosis of specific allergy sensitivity but does not include immunotherapy should be coded according to the level of care rendered.

Maximize Allergy Immunotherapy Reimbursements with BillingFreedom

At BillingFreedom, we specialize in accurate and compliant billing for allergen immunotherapy services. Our expert medical billing team adheres to the latest Medicare and CPT coding guidelines, including the proper use of component codes, antigen preparation rules, and catch-up dosing requirements. We maintain a 98% claim acceptance rate and help practices reduce denials by up to 40%. Every claim is submitted with the correct code selection, accurate dose reporting, and comprehensive documentation to maximize reimbursements.

With BillingFreedom as your billing partner, you can focus on patient care while we handle the complexities of coding and payer compliance. Our streamlined process supports allergy practices in achieving 30% faster payments and 20% higher collections. Whether you provide multi-dose vial preparations, stinging insect venom therapy, or rapid desensitization procedures, BillingFreedom ensures your billing is precise, efficient, and profitable.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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