How To Use CPT Code 95131

CPT 95131 describes the professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified healthcare professional. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 95131?

CPT 95131 can be used to describe the professional services provided by a healthcare professional for allergen immunotherapy. This code is used when the healthcare professional administers a stinging insect venom for two types of insects to a patient in the office or institution to treat or prevent an allergic reaction to the sting.

2. Official Description

The official description of CPT code 95131 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 stinging insect venoms.’

3. Procedure

1. The healthcare professional prepares the patient for the allergen immunotherapy.
2. The healthcare professional administers the allergenic extract for desensitization to the venom of two types of stinging insects.
3. The procedure aims to decrease or prevent allergic reactions by gradually increasing the quantities of the specific allergenic extract over time.
4. The injections are part of a series of injections to achieve clinical tolerance of the allergens.

4. Qualifying circumstances

Patients eligible to receive CPT 95131 services are those who are allergic to the sting of two types of stinging insects and require allergen immunotherapy. The healthcare professional must administer the allergenic extract in the office or institution of the prescribing physician or other qualified healthcare professional.

5. When to use CPT code 95131

CPT code 95131 should be used when a healthcare professional administers a stinging insect venom for two types of insects to a patient in the office or institution. This code should not be used for a single stinging insect venom or for three or more stinging insect venoms.

6. Documentation requirements

To support a claim for CPT 95131, the healthcare professional must document the following information:

• Patient’s allergy to the sting of two types of stinging insects
• Date of the allergen immunotherapy administration
• Specific allergenic extract used for desensitization
• Progress made by the patient in achieving clinical tolerance
• Signature of the healthcare professional providing the service

7. Billing guidelines

When billing for CPT 95131, ensure that the healthcare professional administers the allergen immunotherapy in the office or institution. This code should not be reported with other codes for the preparation of the allergen extract or for additional injections separately. Follow the specific guidelines for reporting CPT 95131 based on the number of stinging insect venoms administered.

8. Historical information

CPT 95131 was added to the Current Procedural Terminology system on January 1, 1990. There have been changes to the code over the years, including updates to the official description.

9. Examples

1. A healthcare professional administering allergen immunotherapy for a patient allergic to the sting of two types of stinging insects in the office.
2. A qualified healthcare professional providing desensitization injections for a patient with a severe allergic reaction to the sting of two types of stinging insects.
3. A prescribing physician administering allergen immunotherapy for a patient with a known allergy to the sting of two types of stinging insects.
4. A healthcare professional gradually increasing the quantities of the allergenic extract for a patient undergoing allergen immunotherapy for two types of stinging insects.
5. A qualified healthcare professional monitoring the progress of a patient receiving allergen immunotherapy for two types of stinging insects in the office.
6. A healthcare professional administering allergen immunotherapy injections for a patient with a history of anaphylaxis to the sting of two types of stinging insects.
7. A prescribing physician providing allergen immunotherapy for a patient with a documented allergy to the sting of two types of stinging insects.
8. A qualified healthcare professional administering allergen immunotherapy injections for a patient with a severe allergic reaction to the sting of two types of stinging insects.
9. A healthcare professional gradually increasing the doses of the allergenic extract for a patient undergoing desensitization to the venom of two types of stinging insects.
10. A prescribing physician monitoring the clinical tolerance progress of a patient receiving allergen immunotherapy for two types of stinging insects.