Reader Question: 95144 or 95165?

Question: How does 95144 differ from 95165?

New York Reader

Answer: Although both 95144 (professional services for the supervision and provision of antigens for allergen, single dose vials [specify number of vials]) and 95165 (professional services for the supervision and provision of antigens for allergen; [specify number of doses]) describe the preparation of antigen, they differ significantly.

Typically, providers prepare multidose vials of antigen that they later administer to their patients. This preparation is coded 95165. In some cases, however, the provider needs to prepare single-dose vials, either for another physician to administer or, in some cases, for the patient to self-administer.

For example, if during the course of allergy treatments the patient has to travel and therefore will miss four treatments, the provider may prepare four single-dose vials that the patient can use while away. By measuring out a single dose in a vial, whoever uses the allergen the patient or another physician does not have to measure it or worry about dosage. The preparation of the vials would be coded 95144, with a 4 in the units box on the HCFA 1500 claim form.

Single-dose vials are unlikely to be prepared for patients who see the physician in the office, and many carriers will not pay for the preparation of these individual vials if injection is performed in the office.

Note: The preparation of single-dose vials should not be confused with allergy injections off the board, for which the allergist prepares the dose and immediately injects the patient without storing the antigen(s) in a vial.


- Published on 2001-06-01