How To Use CPT Code 95125

CPT 95125 describes the professional services for allergen immunotherapy provided by a qualified healthcare professional in their office or institution. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95125?

CPT 95125 can be used to describe the professional services provided by a qualified healthcare professional for allergen immunotherapy. This code is used when the provider administers two or more injections of a specific allergenic extract to a patient during a session.

2. Official Description

The official description of CPT code 95125 is: ‘Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified healthcare professional, including provision of allergenic extract; 2 or more injections.’

3. Procedure

  1. The qualified healthcare professional prepares the allergenic extracts for immunotherapy.
  2. During the session, the provider administers two or more injections of the allergenic extract to the patient.
  3. The injections are administered gradually over time to achieve clinical tolerance of the allergens and minimize allergic reactions.
  4. The goal of allergen immunotherapy is to decrease the patient’s sensitivity to allergens and provide lasting relief of allergy symptoms.
  5. The provider may administer the injections periodically, gradually increasing the quantities of the allergenic extract.
  6. The procedure aims to help the patient develop tolerance to the allergens with fewer or no symptoms.

4. Qualifying circumstances

Patients eligible to receive CPT 95125 services are those who require allergen immunotherapy. This procedure is suitable for individuals who experience allergic reactions to specific substances and need to develop tolerance to those allergens. The qualified healthcare professional must administer two or more injections of the allergenic extract during the session.

5. When to use CPT code 95125

CPT code 95125 should be used when a qualified healthcare professional administers two or more injections of an allergenic extract to a patient during a session. This code is appropriate for reporting each session that involves multiple injections. If only a single injection is administered, CPT code 95120 should be used instead.

6. Documentation requirements

To support a claim for CPT 95125, the healthcare professional must document the following information:

  • Reason for allergen immunotherapy
  • Details of the allergenic extract used
  • Date and duration of the session
  • Number of injections administered
  • Progress made by the patient
  • Any adverse reactions or side effects
  • Signature of the qualified healthcare professional

7. Billing guidelines

When billing for CPT 95125, ensure that the healthcare professional administering the injections is qualified and that two or more injections are provided during the session. It is important to follow the specific guidelines and rules set by the payer for accurate billing. Additionally, consider any modifiers that may be required for proper reimbursement.

8. Historical information

CPT 95125 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been a few changes to the code, including updates to the official description and wording.

9. Examples

  1. A qualified healthcare professional administering two injections of an allergenic extract for a patient with severe seasonal allergies.
  2. A provider gradually increasing the quantities of an allergenic extract during a session, administering three injections for a patient with multiple food allergies.
  3. A qualified healthcare professional administering four injections of an allergenic extract to a patient with persistent allergic rhinitis.
  4. A provider administering two injections of an allergenic extract to a patient with allergic asthma, aiming to decrease their sensitivity to allergens.
  5. A qualified healthcare professional administering two injections of an allergenic extract to a patient with insect venom allergies, helping them develop tolerance to the allergens.
  6. A provider administering three injections of an allergenic extract to a patient with pet allergies, aiming to provide lasting relief of allergy symptoms.
  7. A qualified healthcare professional administering two injections of an allergenic extract to a patient with allergic conjunctivitis, aiming to minimize their allergic reactions.
  8. A provider gradually increasing the quantities of an allergenic extract during a session, administering four injections to a patient with multiple environmental allergies.
  9. A qualified healthcare professional administering two injections of an allergenic extract to a patient with allergic dermatitis, aiming to decrease their sensitivity to allergens.
  10. A provider administering three injections of an allergenic extract to a patient with allergic sinusitis, aiming to provide lasting relief of allergy symptoms.

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