Pulmonology Coding Alert

Question: Our office has decided to provide allergy injections (different medications) for allergen immunotherapy. How do we report such services?

Nebraska Subscriber

Answer: According to CMS rules, pulmonologists and allergists must identify and report each provided service (allergen preparation/provision and administration) separately.

If the physician administers a single allergen injection, you will report it with 95115 (Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection). For two or more injections, you have to report code 95117 (Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections). The antigens and their preparation are represented by codes 95144-95170 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy). 

If your physician provides both the injection and the antigen or prepares the antigen, select one code for the injection/administration (95115 or 95117) and one code from 95144-95170 for the antigen preparation and provision.

According to the Medicare Carriers Manual Section 15050B.3, single-dose vials are used to ensure proper dosages for the injection. They cost more and are reimbursed at a higher rate. Allergists who prepare and provide antigens should be able to do so from the cost-efficient, multidose vials. Thus, Medicare instructs billing 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) for antigen preparation and provision instead of 95144 when reporting this service with the administration, 95115 or 95117. 

Whether a single- or multidose vial is used or reported, Medicare will reimburse only for the multidose vial rate, i.e., 95165. Medicare pays for 95144 only when the antigen is prepared for injection by another entity.

The fee schedule amounts for 95144-95170 are for a single dose. When billing these codes, physicians should specify the number of doses provided. CMS Program Memo B-00-53 has identified a “dose” as a 1-cc aliquot from a multidose vial, and the limitation for potency of the allergen extract as 12 months. It instructs carriers to multiply the fee schedule amount by the number of doses specified in the units field.

If a physician only provides the administration of the allergen, report 95115 or 95117 as appropriate. Administration services differ from provision/preparation services in that the administration codes are reported once per patient encounter in which the allergy shot was performed , and provision/preparation is reported once with multiple units for the encounter in which the extract is developed .