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Thread: Allergy injections

  1. #1

    Default Allergy injections

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    Is there anyone out there proficient in allergy coding? I have an instance that I've stumbled upon in which a patient was ordered to have allergy injections. The allergist mixed the antigens one day and charged out 95165 x 35 (he mixed 35 doses that day). About a month from that day, the pt presented for an allergy shot and the nurse charged out 95115 and 95120...This is charged this way for about 4 visits. Then at the fifth and sixth visit, they charged out 95117. Then about the next 5 visits after that, they charged out pxs 95115 and 95120... I am confused as to why they are charging out the 95115 and 95120 at each injection when the allergist mixed 35 doses and charged for them?? I have read up on these codes and it seems to me if the allergist is charging out that 95165 x 35 for the antigens (35 doses) then they shouldn't be charging the 95120 in addition if they are giving a single injection. Am I correct?? This 95120 should only be charged if they were mixing the single dose of antigen for that injection right there at the time of the injection correct? if they charged out the 95165 then are charging the 95120 each time isn't it like they're charging double for the antigen dose? If anyone who is proficient with coding allergy could let me know what they think in addition to any confirming documentation they may have, I would really appreciate it!

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    According to CPT Assistant 2/05 vol 15 issue 2:
    (and i just copied this portion)-

    Codes 95115-95117 describe the professional service of administration of allergenic extract -the injection itself- but do not include the actual supply of the allergenic extract that is given. These injection codes may be used by the allergist who bills separately for the injection and for the prospectively prepared supply of allergenic extract (see codes 95144-95170 for reporting supply of the extract). Similarly, the injection codes may be used a by a physician (eg, primary care physician) who administers the allergy injection only, using allergenic extract brought to the office by the patient and previously prepared by the patient's allergist.

    Codes 95120-95134 are complete service codes representing the combined supply of antigen plus the allergy injection provided at a single encounter. These codes are used infrequently and are recommended in those cases only where the payer specifically requires them. As explained under CMS Guidelines, Medicare does not allow payment of these codes.

    If you report 95115 and 95120 and have already billed 95165 you are duplicating the billing for provision of the antigen. 95120-95134 include provision of antigen, so you cannot code another provision when you have done that already with 95165x##. The correct way to bill for the patient receiving the shots is 95115 or 95117 since the antigen has already been mixed.

    I hope that helps.
    Lisa Bledsoe, CPC, CPMA

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