How To Use CPT Code 95165

CPT 95165 describes the professional services for the supervision and provision of antigens for allergen immunotherapy. 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 95165?

CPT 95165 can be used to describe the professional services provided by a healthcare provider for the supervision and provision of antigens for allergen immunotherapy. This code is used when the provider prepares one or more antigen vials for injection, with the aim of overcoming or minimizing allergic reactions in patients.

2. Official Description

The official description of CPT code 95165 is: ‘Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses).’

3. Procedure

1. In this procedure, the healthcare provider mixes and prepares the antigens for allergen immunotherapy.
2. The provider selects the appropriate antigens based on the patient’s specific allergies and prepares one or more antigen vials.
3. The prepared vials include multiple doses of the antigens.
4. The provider ensures that the antigens are properly labeled and stored for future use.
5. The provider may also provide instructions to the patient on how to administer the antigens at home.
6. Additional doses may be prepared and administered as needed for the patient’s allergen immunotherapy treatment.

4. Qualifying circumstances

CPT 95165 is used for patients who require allergen immunotherapy. This procedure is typically performed for patients who have allergies to specific substances and experience severe allergic reactions. The healthcare provider must be responsible for the supervision and provision of the antigens for immunotherapy. The antigens are prepared in one or more vials, and each vial contains multiple doses of the antigens.

5. When to use CPT code 95165

CPT code 95165 should be used when a healthcare provider prepares one or more antigen vials for allergen immunotherapy. This code is appropriate when the provider is responsible for the supervision and provision of the antigens and when each vial contains multiple doses of the antigens. It is important to specify the number of doses in the documentation.

6. Documentation requirements

To support a claim for CPT 95165, the healthcare provider must document the following information:

• The specific allergens for which the antigens are prepared
• The number of doses in each antigen vial
• Date of preparation
• Instructions for administration, if applicable
• Signature of the healthcare provider responsible for the preparation

7. Billing guidelines

When billing for CPT 95165, ensure that the healthcare provider is responsible for the supervision and provision of the antigens for allergen immunotherapy. Report one unit of 95165 for each dose of antigen prepared. It is important to follow the specific guidelines provided by the payer and to use the appropriate modifiers if required.

8. Historical information

CPT 95165 was added to the Current Procedural Terminology system on January 1, 1994. There have been some changes to the code over the years, including a code change on January 1, 2002, which updated the description to include the supervision and provision of antigens for allergen immunotherapy.

9. Examples

1. A healthcare provider prepares a vial of antigens containing multiple doses for a patient with severe peanut allergy.
2. A provider prepares two vials of antigens, one for grass pollen and one for dust mites, each containing multiple doses, for a patient with allergies to both substances.
3. A healthcare provider prepares a vial of antigens containing multiple doses for a patient with severe cat allergy.
4. A provider prepares three vials of antigens, one for tree pollen, one for ragweed, and one for mold, each containing multiple doses, for a patient with multiple allergies.
5. A healthcare provider prepares a vial of antigens containing multiple doses for a patient with severe bee venom allergy.
6. A provider prepares two vials of antigens, one for tree nuts and one for shellfish, each containing multiple doses, for a patient with allergies to both substances.
7. A healthcare provider prepares a vial of antigens containing multiple doses for a patient with severe dust mite allergy.
8. A provider prepares three vials of antigens, one for cat dander, one for dog dander, and one for cockroach allergen, each containing multiple doses, for a patient with multiple allergies.
9. A healthcare provider prepares a vial of antigens containing multiple doses for a patient with severe grass pollen allergy.
10. A provider prepares two vials of antigens, one for mold and one for weed pollen, each containing multiple doses, for a patient with allergies to both substances.