Summary & Overview
CPT 95115: Allergen Immunotherapy, Single Injection
CPT code 95115 is a widely used billing code for professional services related to allergen immunotherapy, specifically for the administration of a single injection. This code is significant in allergy and immunology practices across the United States, as it enables providers to bill for the clinical service of administering immunotherapy to patients with various allergic conditions. The code does not include the cost or provision of allergenic extracts, focusing solely on the injection service itself.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare recognize and reimburse for CPT 95115, making it a key code for practices specializing in allergy and immunology. The publication provides an overview of payer coverage, clinical context, and policy updates relevant to this procedure. Readers will gain insights into typical sites of service, common clinical indications, and related codes, as well as current benchmarks and billing considerations for allergen immunotherapy. The summary also highlights the importance of understanding payer-specific requirements and modifiers associated with this code, ensuring accurate billing and compliance in clinical practice.
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 & Coding Specifications
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
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Modifiers:
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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.
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Provider Taxonomies:
Taxonomy Code