Pulmonology Coding Alert

Question: What is the proper way to bill for CPT^® code 95165 preparation and supervision of immunotherapy and the injection code 95117 for this to Medicare?

Utah Subscriber

Answer: Use 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]) to report multiple dose vials of a non-venom antigen. When reporting 95165, you should report the number of units of 1 cc doses being prepared. Medicare allows a maximum of 10 doses per vial even if you administered more than ten doses from one vial.

In cases where a multi-dose vial is diluted, do not bill Medicare these preparations in excess of the 10 doses per vial as permissible under 95165. Always use the codes that represent the your provider’s participation in immunotherapy such as 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection), 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections), 95144-95170 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy…) when reporting allergy immunotherapy services. In case your physician did not prepare the extracts, report the injection-only codes (95115 and 95117).