How To Use CPT Code 95117

CPT 95117 refers to professional services for allergen immunotherapy involving two or more injections, not including the provision of allergenic extracts. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 95117.

1. What is CPT 95117?

CPT 95117 is a medical billing code used to describe professional services for allergen immunotherapy, specifically when a patient receives two or more injections during a single visit. This code does not include the provision of allergenic extracts. Allergen immunotherapy aims to desensitize a patient to specific allergens, reducing or eliminating their allergic reactions.

2. 95117 CPT code description

The official description of CPT code 95117 is: “Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections.”

3. Procedure

The 95117 procedure involves the following steps:

1. The patient is assessed for allergies and the appropriate allergenic extracts are determined.
2. The allergenic extracts are prepared and provided separately from the injection service.
3. The provider administers two or more injections of allergen extracts to the patient during a single visit.
4. The patient’s response to the injections is monitored, and any necessary adjustments to the treatment plan are made.
5. Follow-up visits are scheduled for additional injections as needed.

4. Qualifying circumstances

Patients eligible to receive CPT code 95117 services are those who have been diagnosed with allergies and are undergoing allergen immunotherapy. This therapy is typically recommended for patients who have not responded well to other allergy treatments, such as medications or avoidance strategies. The patient must receive two or more injections during a single visit for the service to be billed under CPT 95117.

5. When to use CPT code 95117

It is appropriate to bill the 95117 CPT code when a patient receives two or more injections of allergen extracts during a single visit as part of their allergen immunotherapy treatment plan. This code should not be used for single injections or for the provision of allergenic extracts, as separate codes exist for these services.

6. Documentation requirements

To support a claim for CPT 95117, the following information should be documented:

• Patient’s allergy diagnosis and history
• Details of the allergenic extracts used, including their preparation and provision
• Number of injections administered during the visit
• Any adverse reactions or complications experienced by the patient
• Follow-up appointments and future treatment plans

7. Billing guidelines

When billing for CPT code 95117, keep in mind the following guidelines and tips:

• Use CPT 95117 for two or more injections of allergen extracts. For a single injection, use CPT 95116.
• Do not include the preparation and supply of allergen extracts in the billing for CPT 95117. Use codes 94144 and 95165 for these services.
• For Medicare patients, use injection codes 95115 and 95117 along with supervision of preparation and provision codes 94144 and 95165.
• Allergy testing and immunotherapy should not be reported together, as they are generally not performed during the same visit.
• If a significant, separately identifiable E/M service is performed during the same visit, use an appropriate E/M code with the modifier 25.
• Do not use code 96372 for allergen extract injections, as this code is for subcutaneous or intramuscular therapeutic, prophylactic, or diagnostic injections.

8. Historical information

CPT 95117 was added to the Current Procedural Terminology system on January 1, 1990. The code’s description was changed on January 1, 2009, from “Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections” to its current description.

9. Similar codes to CPT 95117

Five similar codes to CPT 95117 and how they differ are:

• CPT 95115: This code is used for a single injection of allergen extracts, rather than two or more injections.
• CPT 95116: This code is also used for a single injection of allergen extracts but does not include the provision of allergenic extracts.
• CPT 95120: This code includes both the provision of allergenic extracts and a single injection.
• CPT 95125: This code includes both the provision of allergenic extracts and two or more injections.
• CPT 96372: This code is for subcutaneous or intramuscular therapeutic, prophylactic, or diagnostic injections, not allergen extract injections.

10. Examples

Here are 10 detailed examples of CPT code 95117 procedures:

1. A patient with seasonal allergies receives two injections of pollen allergen extracts during a single visit.
2. A patient with a dust mite allergy receives three injections of dust mite allergen extracts during a single visit.
3. A patient with multiple food allergies receives two injections of food allergen extracts during a single visit.
4. A patient with a pet allergy receives two injections of pet allergen extracts during a single visit.
5. A patient with a mold allergy receives three injections of mold allergen extracts during a single visit.
6. A patient with a latex allergy receives two injections of latex allergen extracts during a single visit.
7. A patient with a bee venom allergy receives two injections of bee venom allergen extracts during a single visit.
8. A patient with a grass allergy receives three injections of grass allergen extracts during a single visit.
9. A patient with a tree pollen allergy receives two injections of tree pollen allergen extracts during a single visit.
10. A patient with a ragweed allergy receives two injections of ragweed allergen extracts during a single visit.