Pulmonology Coding Alert

Question: When a patient receives antigen therapy from our pulmonologist, what CPT code[s] should I use for the encounter?


Missouri Subscriber


Answer: It depends on whether or not the physician prepares the antigen himself. Let's say the physician prepares the antigen and performs three injections. On the claim, you should:

• report 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections) to represent the injection service. Use 95117 only once per claim regardless of the number of injections.

• report 95165 x 3 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) for the physician's work supervising and providing the antigens.  Make sure to report the total number of doses prepared, regardless of the number the physician injects during this visit.

However: Your pulmonologist may not prepare and inject the antigen; he may be providing the antigen to another physician to perform the injection. When your pulmonologist prepares a single-dose vial but does not inject the patient, report 95144 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single dose vial[s] [specify number of vials]) for the encounter. When preparing the more common multi-dose vial for another physician, report only 95165 with the total number of doses prepared (e.g.., 95165 x 20).