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CPT Code 95117 | Description, Procedure & Billing Guidelines (2022)

Report CPT 95117 for two or more injections of allergenic extracts to help a patient overcome or reduce the allergic reaction to a specific allergen.

1. What Is CPT Code 95117?

CPT 95117 covers two or more injections of allergenic extracts to make a patient less sensitive to an allergen. The result can be fewer or no allergic reactions to a specific allergen.

2. What Is An Allergic Reaction?

The procedure, described by CPT 95117, helps a patient overcome or reduce an allergic reaction.

An allergic reaction can cause a severe reaction in a patient’s body which is allergic to a specific substance that seems harmless to others.

The allergic reaction is caused by an allergic substance/allergen entering the patient’s body. The body will fight the allergen with antibodies (produced by white blood cells) called immunoglobulin E. The antibodies attack the allergen and stick to it.

Then, the body releases chemicals like histamine that tricker an inflammatory response in a patient. This can result in the following symptoms;

  • itching;
  • swelling; and
  • redness.

3. Description

The CPT book describes CPT code 95117 as: “Professional services for allergen immunotherapy not including the provision of allergenic extracts; 2 or more injections.”

4. Procedure

The goal of this procedure is to desensitize a patient to a specific allergen.

The 95117 CPT code procedure starts with the preparation of a patient before the injections are administered. Then, the provider gives the patient two or more injections of the allergen extracts.

Allergen immunotherapy is provided to help the patients by minimizing (or overcoming) an allergic reaction by administering a purified allergen injection, allowing patients to develop tolerance to the allergen.

This procedure results in the patient having fewer or no symptoms of the allergens.

5. Billing Guidelines

CPT code 95117 can only be reported for two or more allergen extract injections. Report CPT 95116 if only one injection were provided.

CPT 95117 does not cover the supply and preparation of the allergen extracts.

You could report CPT 95117 with modifier 25 if a separately identifiable Evaluation and Management service were provided during the same visit to administer the allergen injections.

Be aware that you should not report allergy immunotherapy and testing on the same date. They are usually performed on different dates.

You may also use CPT 95120 and CPT 95125 for allergen immunotherapy. These codes include the administration of allergen extracts (one or two injections).

You can not use these codes when you bill Medicare. Instead, use injection codes CPT 95115 and CPT 95117 and the supervision of preparation and provision codes CPT 94144 and CPT 95165 for Medicare patients. 

See CPT 94144 and CPT 95165 for the provision and supervision of the preparation of the antigens used for allergen immunotherapy.

6. Resources

CPT Professional 2022

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56424&ver=12

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