Otolaryngology Coding Alert

Question: How should I charge 95165 for an immunotherapy allergen kit? We make a kit to last a year and administer one per week. The code specifies the number of doses. What code should I use for the shot?

California Subscriber

Answer: A dose is the amount of antigen given to a patient who is fully desensitized. So, a dose = 1 cc. When billing 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]), you should bill the number of units based on the prepared number of 1-cc doses a fully desensitized patient will receive even if the vial contains more doses due to the desensitization process.

For example, the otolaryngologist prepares eight concentrated 1-cc doses in a single vial. You should report 95165 with an "8" in the units field.

If a patient is not fully desensitized, he receives a diluted solution equal to a partial cc. Therefore, one vial could last for 15-17 injections. Medicare, however, will pay for 8 units only, the number of concentrated 1-cc doses.

Do not bill Medicare for more than 10 doses per vial, even if more are obtained from the vial. Medicare and most payers will not pay for dilutants; they will only pay for the concentrated extract that is in the vial. For the injection, report 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) for a single injection and 95117 (... two or more injections) for multiple injections.