Pulmonology Coding Alert

Question: What are the administration and CPT codes for allergy immunotherapy? What are the guidelines for using them?

Tennessee Subscriber

Answer: The pulmonologist must be in the office when the injection is given, and a statement documenting this must be provided in Box 31 of the CMS-1500 form.

Codes that apply to immunotherapy include 95115-95199. Two specific codes billed to Medicare are allowed for injection services (95115 and 95117). Codes 95115 and 95117 are for injections only and do not include antigen provision (95120-95134; 95144; 95165). The office that administers the injection bills 95115 or 95117. The extract or antigen provision codes are billed by the office that prepares the injection therapy. The injection codes include 30 minutes of physician supervision to monitor for an allergic reaction. The codes also preclude a pulmonologist's office from billing a separate E/M code for the visit by appending modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service involved in the office visit when no other health issue has been addressed.

When 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single dose vial[s] [specify number of vials]) and 95115-95117 are performed together, they should never be reported separately. Bill these services under the comprehensive code 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]).