CPT Code Overview

CPT 95115 represents professional services for allergen immunotherapy, specifically for a single injection. This procedure is part of the Allergy and Clinical Immunology Procedures service type and is typically performed in a clinical setting such as a physician's office. The code covers the administration of immunotherapy to help manage allergic conditions, but does not include the provision of allergenic extracts. This service is commonly used for patients requiring ongoing allergy treatment under the supervision of a specialist.

Clinical Context

A patient with a history of allergic rhinitis, asthma, or allergic conjunctivitis presents to the office of an allergy and immunology specialist. After evaluation and confirmation of the diagnosis, the provider determines that allergen immunotherapy is indicated. The patient receives a single injection of allergenic extract as part of their ongoing immunotherapy regimen. The procedure is performed in a clinical setting, such as a physician's office, under the supervision of a qualified allergy and immunology provider. The visit may include assessment of symptoms, review of previous reactions, and monitoring for adverse effects post-injection.

Coding Specifications

• Modifiers:

  • Modifier 25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the allergen immunotherapy injection. This modifier distinguishes the E/M service from the procedure.

  • Modifier 59: Used to indicate a distinct procedural service, such as when the allergen immunotherapy injection is performed separately from other procedures or services on the same day.

• Provider Taxonomies:

  Taxonomy Code	Specialty Name
  207K00000X	Allergy & Immunology Physician
  207RA0201X	Allergy Physician
  207RI0008X	Clinical & Laboratory Immunology Physician

These taxonomies represent providers specializing in allergy, immunology, and clinical laboratory immunology.

Related Diagnoses

• H10.411 – Chronic giant papillary conjunctivitis, right eye

  • Relevant for patients with chronic allergic conjunctivitis affecting the right eye, who may benefit from allergen immunotherapy.

• H10.412 – Chronic giant papillary conjunctivitis, left eye

  • Indicates chronic allergic conjunctivitis in the left eye, supporting the need for immunotherapy.

• H10.413 – Chronic giant papillary conjunctivitis, bilateral

  • Bilateral involvement of chronic allergic conjunctivitis, often managed with allergen immunotherapy.

• H10.45 – Other chronic allergic conjunctivitis

  • Covers other forms of chronic allergic conjunctivitis, which may be treated with immunotherapy.

• J30.0 – Vasomotor rhinitis

  • Non-allergic rhinitis that may be considered for immunotherapy if symptoms are severe.

• J30.1 – Allergic rhinitis due to pollen

  • Common indication for allergen immunotherapy, especially during pollen seasons.

• J30.2 – Other seasonal allergic rhinitis

  • Includes allergic rhinitis triggered by seasonal allergens, suitable for immunotherapy.

• J30.81 – Allergic rhinitis due to animal (cat) (dog) hair and dander

  • Patients allergic to animal dander may receive immunotherapy to reduce symptoms.

• J30.89 – Other allergic rhinitis

  • Encompasses other types of allergic rhinitis, often managed with immunotherapy.

• J31.0 – Chronic rhinitis

  • Chronic rhinitis may be treated with immunotherapy if allergic etiology is confirmed.

• J45.20 – Mild intermittent asthma, uncomplicated

  • Asthma patients with mild intermittent symptoms may benefit from allergen immunotherapy.

• J45.30 – Mild persistent asthma, uncomplicated

  • Immunotherapy may be indicated for mild persistent asthma with allergic triggers.

• J45.40 – Moderate persistent asthma, uncomplicated

  • Moderate persistent asthma with allergic components can be managed with immunotherapy.

• J45.50 – Severe persistent asthma, uncomplicated

  • Severe asthma patients may receive immunotherapy as part of their treatment plan.

• T63.421A – Toxic effect of venom of ants, accidental (unintentional), initial encounter

  • Relevant for patients undergoing immunotherapy for ant venom allergy, initial visit.

• T63.421D – Toxic effect of venom of ants, accidental (unintentional), subsequent encounter

  • Used for follow-up visits in ant venom immunotherapy.

• T63.421S – Toxic effect of venom of ants, accidental (unintentional), sequela

  • Indicates sequelae from ant venom exposure, managed with immunotherapy.

Related CPT Codes

• 95117 – Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections at a single visit

  • Used when multiple injections are administered during the same visit. It is an alternative to 95115 when more than one injection is given.

• 95144 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (single-dose vials) when performed by the allergist

  • Used for the preparation and provision of allergenic extracts in single-dose vials. May be used in conjunction with injection codes when the allergist prepares the extracts.

• 95165 – Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens

  • Used for the preparation and provision of allergenic extracts in multi-dose vials. Often billed alongside injection codes when the provider supervises the preparation of antigens.

These codes are commonly used together in the clinical workflow for allergen immunotherapy, depending on the number of injections and the preparation of extracts.