Reader Questions: Report 95180 for Cluster Shots

Question: How should we bill for cluster shots for new patients who are building up maintenance doses for immunotherapy? Sometimes, patients receive up to eight shots in one day, and each dose may be two injections, depending on the amount of the dose. Is there a way to report this for full reimbursement for all the shots administered during an immunotherapy treatment?

Michigan Subscriber

Answer: Cluster immunotherapy is very similar to a "rush" or "rapid desensitization" treatment (95180, Rapid desensitization procedure, each hour [e.g., insulin, penicillin, equine serum]), during which a patient spends the entire day in the office. He proceeds through several concentrations of immunotherapy, often reaching a full maintenance dose in one day. For such treatments, report 95180 (1 unit per hour) x eight units, for instance, if the patient receives eight shots.
 
This "clustering" differs from regular immunotherapy 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 ( two or more injections) in that there are waiting periods between the shots to allow for patient observation for each hour he is in your office.
 
Keep in mind that some insurance companies may not cover cluster shots (although most do), and some may require precertification for these shots. So check with your carriers for specific requirements.