How To Use CPT Code 95133

CPT 95133 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 four stinging insect venoms. 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 95133?

CPT 95133 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 allergenic extract for four stinging insect venoms in the office or institution of the prescribing physician or other qualified healthcare professional. The purpose of this procedure is to treat or prevent allergic reactions in patients who are allergic to these insect venoms.

2. Official Description

The official description of CPT code 95133 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; 4 stinging insect venoms.’

3. Procedure

1. The healthcare professional prepares the patient for the allergen immunotherapy procedure.
2. The healthcare professional administers the allergenic extract for four stinging insect venoms to the patient.
3. The procedure aims to desensitize the patient to these allergens and decrease or prevent allergic reactions.
4. The injections are typically part of a series of injections over time, gradually increasing the quantities of the allergenic extract to achieve clinical tolerance.
5. The healthcare professional may provide additional instructions or recommendations to the patient regarding the management of allergic reactions and the continuation of the immunotherapy treatment.

4. Qualifying circumstances

CPT 95133 is applicable to patients who are allergic to the venom of four specific stinging insects and require allergen immunotherapy. The procedure must be performed in the office or institution of the prescribing physician or other qualified healthcare professional. The healthcare professional administering the allergenic extract must be authorized and qualified to perform this procedure.

5. When to use CPT code 95133

CPT code 95133 should be used when a healthcare professional provides allergen immunotherapy services for four stinging insect venoms in the office or institution setting. It is important to ensure that the patient meets the qualifying circumstances and that the procedure is performed by a qualified healthcare professional in the appropriate setting.

6. Documentation requirements

To support a claim for CPT 95133, the healthcare professional must document the following information:

• Patient’s diagnosis and indication for allergen immunotherapy
• Specific allergenic extract used for the procedure
• Date of the procedure
• Details of the injections administered, including the four stinging insect venoms
• Instructions or recommendations provided to the patient
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 95133, it is important to ensure that the procedure is performed by a qualified healthcare professional in the office or institution setting. The code includes both the provision of the allergenic extract and the administration of the injections. It should not be reported with other codes for the preparation of the allergen extract or for additional injections separately. It is crucial to follow the specific guidelines and tips provided by the payer and coding authorities for accurate billing and reimbursement.

8. Historical information

CPT 95133 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, including updates on January 1, 2009, and January 1, 2013. These changes reflect modifications to the description and inclusion of specific stinging insect venoms.

9. Examples

1. A healthcare professional administers allergen immunotherapy for four stinging insect venoms to a patient who has a severe allergic reaction to these insects.
2. In the office setting, a qualified healthcare professional provides allergen immunotherapy for four stinging insect venoms to a patient who wants to prevent future allergic reactions.
3. A prescribing physician performs allergen immunotherapy for four stinging insect venoms in their institution to desensitize a patient with a known allergy to these insects.
4. A qualified healthcare professional administers allergen immunotherapy for four stinging insect venoms to a patient who has experienced anaphylaxis due to these insects.
5. In the office of a qualified healthcare professional, allergen immunotherapy is provided for four stinging insect venoms to a patient who wants to reduce the severity of their allergic reactions.
6. A healthcare professional performs allergen immunotherapy for four stinging insect venoms in the institution to help a patient build tolerance to these allergens.
7. A qualified healthcare professional administers allergen immunotherapy for four stinging insect venoms to a patient who frequently encounters these insects in their environment.
8. In the office setting, a prescribing physician provides allergen immunotherapy for four stinging insect venoms to a patient who wants to minimize the risk of an allergic reaction.
9. A healthcare professional performs allergen immunotherapy for four stinging insect venoms in their institution to help a patient overcome their severe allergy to these insects.
10. A qualified healthcare professional administers allergen immunotherapy for four stinging insect venoms to a patient who wants to improve their quality of life by reducing the impact of allergic reactions.