Summary & Overview
CPT 95130: Office Administration of Stinging Insect Venom
CPT code 95130 represents in-office administration of stinging insect venom for a single insect species to treat or prevent allergic reactions in sensitized patients. Nationwide, venom immunotherapy is a clinically important intervention for patients at risk of systemic reactions to insect stings; accurate coding supports appropriate clinical documentation and payer adjudication. Key national payers include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical purpose of 95130, the typical ambulatory setting for this service, and which major payers commonly cover venom immunotherapy administration. The publication summarizes coding context, common modifiers used with this service, and provides national benchmarking and policy context where available. It also outlines clinical implications for allergists and other office-based providers who deliver venom immunotherapy and highlights documentation elements that influence medical necessity determinations. Data not available in the input is noted where applicable, and the focus remains on national coverage and coding considerations rather than state-specific rules.
Billing Code Overview
CPT code 95130 describes the administration of a stinging insect venom for a single type of insect in the office to treat or prevent an allergic reaction in a patient with venom hypersensitivity. This service involves a healthcare provider delivering venom immunotherapy (VIT) in an ambulatory clinical setting.
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Service type: Office-based venom immunotherapy administration
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Typical site of service: Ambulatory clinic or physician office
Clinical & Coding Specifications
Clinical Context
A 35-year-old patient with a documented systemic allergic reaction to a hymenopteran sting presents to an allergy clinic for venom immunotherapy. The clinician reviews the patients history, verifies prior sting reactions and specific IgE or skin test results identifying sensitivity to a single insect venom (for example, yellow jacket). After informed consent, baseline vital signs are obtained and emergency resuscitation equipment is made available. The provider prepares and administers a measured dose of the appropriate stinging insect venom extract in the office, observes the patient for an appropriate monitoring period for systemic or local adverse reactions, and documents dose, lot number, site, and post-administration status. The typical workflow includes pre-injection assessment, verification of the correct venom for a single insect type, administration of the dose by the provider, post-dose observation, and documentation including any management of adverse events. Typical site of service is an outpatient allergy clinic or physician office. Service type is in-office therapeutic injection/allergen immunotherapy for a single insect venom.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day | Use when an E/M visit is performed on the same day as the immunotherapy and is separately documented and significant beyond the procedure |
| | Professional component | Use when reporting only the professional component of a service that has a technical component (rare for this injection but applicable if applicable billing separates components)