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Sublingual Immunotherapy CPT 95165

  1. #1
    Alexandria, LA
    Default Sublingual Immunotherapy CPT 95165
    Medical Coding Books

    I am in need of some references to help prove to my physician that Sublingual Immunotherapy (Sublingual Drops) cannot be billed to insurance companies using CPT 95165. There is a company telling my physician that the verbage of 95165 has changed and that it is OK to bill using that code. I have been unable to find any such documentation. Everything I can find from various insurance companies show that using that code for SLIT is an intentional misuse of the code and a fradulent practice. The proper code should be 95199 which is nonpayable except for 3 FDA approved sublingual drops and very limited insurance plans.

    If anyone has any pertinent information, please share that with me.

    Thank you so much!!!

    Wanda Wages
    Precision Practice Services

    Wanda S. Wages, CPC
    Precision Practice Services of Louisiana

  2. #2
    CPT Assistant January 2013 page 9 states in part:

    "Codes in the 95115-95199 series are used to report allergen immunotherapy. Immunotherapy (desensitization, hyposensitization) is the injection of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale." (Emphasis added.)

    Immunotherapy is specifically defined on page 576 of the 2014 CPT Codebook Professional Edition as the "parenteral administration of allergenic extracts . . . ." (Emphasis added.)

  3. #3
    Alexandria, LA
    Thank you so much for your reply. That's exactly what I was looking at, but just wanted someone else to confirm that I was reading it correctly. Also that CPT Assistant Reference is great.

    Thanks Again!!!

    Wanda S. Wages, CPC
    Precision Practice Services of Louisiana

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