How To Use CPT Code 95130

CPT code 95130 describes the professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified healthcare professional, including the provision of allergenic extract for a single stinging insect venom. 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 95130?

CPT 95130 can be used to describe the professional services provided by a healthcare professional for allergen immunotherapy. Specifically, this code is used when the healthcare professional administers a stinging insect venom for a single type of insect in the office or institution setting. The purpose of this treatment is to prevent or treat allergic reactions in patients who are allergic to the sting of that particular insect.

2. Official Description

The official description of CPT code 95130 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; single stinging insect venom.’

3. Procedure

1. After appropriate preparation of the patient, the healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom.

4. Qualifying circumstances

CPT 95130 is used for patients who require allergen immunotherapy for a single stinging insect venom. This code is applicable when the healthcare professional administers the allergenic extract in the office or institution setting. It is important to note that this code is specific to a single type of insect venom.

5. When to use CPT code 95130

CPT code 95130 should be used when a healthcare professional administers an allergenic extract for a single stinging insect venom in the office or institution setting. It is important to ensure that the service provided aligns with the specific requirements outlined in the code description.

6. Documentation requirements

To support a claim for CPT 95130, the healthcare professional must document the following information:

• Patient’s diagnosis and indication for allergen immunotherapy
• Specific allergenic extract used for desensitization
• Date and location of the service
• Details of the administration process
• Signature of the healthcare professional providing the service

7. Billing guidelines

When billing for CPT 95130, ensure that the service is provided by a prescribing physician or other qualified healthcare professional. The code should be reported for each instance of allergen immunotherapy involving a single stinging insect venom. It is important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT 95130 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2013, which updated the description to include the provision of allergenic extract.

9. Examples

1. A healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the office to prevent allergic reactions in a patient allergic to the sting.
2. A prescribing physician administers an allergenic extract for desensitization to a single stinging insect venom in the institution setting to treat a patient with a known allergy to that particular insect.
3. A qualified healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the office as part of a series of injections to achieve clinical tolerance of the allergen.
4. A healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the institution setting to prevent severe allergic reactions in a patient with a history of anaphylaxis.
5. A prescribing physician administers an allergenic extract for desensitization to a single stinging insect venom in the office to reduce the patient’s sensitivity to the allergen and alleviate allergy symptoms.
6. A qualified healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the institution setting to help the patient develop tolerance to the allergen and minimize allergic reactions.
7. A healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the office to provide lasting relief of allergy symptoms in a patient with a known allergy to that particular insect.
8. A prescribing physician administers an allergenic extract for desensitization to a single stinging insect venom in the institution setting to decrease the patient’s sensitivity to the allergen and prevent future allergic reactions.
9. A qualified healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the office to help the patient develop tolerance to the allergen and reduce the frequency and severity of allergic reactions.
10. A healthcare professional administers an allergenic extract for desensitization to a single stinging insect venom in the institution setting to improve the patient’s quality of life by minimizing the impact of allergic reactions.