Otolaryngology Coding Alert

Question: We have a patient who just moved to our area. Her previous physician shipped us her allergy vials.

She requires two injections per week. What code do we use for her injections and do we charge for two of them?

Our allergy patients only get one injection per week and we use code 95120.

California Subscriber

Answer: The answer depends on how you prepare your patients allergy shots.

If you are preparing the immunotherapy and producing the vials in the office, you bill 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) and the number of doses per vial for your regular patients for most payers, including Medicare.

Note: Medicare limits how many units you may bill for each vial (five, the number of undiluted units in a vial), while private insurance companies do not have a limit and you may bill for the actual number of units in the vial.

Then you bill 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) for one shot or 95117 (... 2 or more injections) for two or more shots.

If you are drawing the serum from a board or ordering the vials you bill 95120 (Professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single injection) for one shot and 95125 (... 2 or more injections) for two or more shots.