Pulmonology Coding Alert

Question: What is the proper way to bill for CPT^® code 95165 preparation and supervision of immunotherapy and the injection code for this- 95117 to Medicare? Can we bill this code with the complete amount of units for one date of service, or do we bill CPT^® 95117 with 2 or 3 units depending on the amount of injection? Kindly help.

Utah Subscriber

Answer: CPT^® procedure code 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) is one of a family of six codes that coders use to report multi-dose vials of certain non-venomous antigens.

When billing code 95165, providers should report the number of units representing the number of 1 cc doses that he administered. Medicare allows billing of a maximum of 10 doses per vial, even if the provider obtained more than ten preparations from the vial. In cases where the provider dilutes a multi-dose vial, remember not to bill Medicare for diluted preparations in excess of the 10 doses per vial, as permissible under code 95165.

Next: Always use the following component codes when reporting allergy immunotherapy services to Medicare.

• 95115 (Professional services for allergen immuno­therapy not including provision of allergenic extracts; single injection)
• 95117 (...2 or more injections),
• 95144-95170 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy...)

In scenario you describe, you may report the injection only codes 95115 and 95117 once and/or the codes representing antigens and their preparation (95144-95170). 95117 represents two or more injection and should not be reported more than once per day.

For more information refer to the link https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/34597_20/L34597_AL.