Summary & Overview
CPT 95131: Stinging Insect Venom Administration for Two Insect Types
CPT code 95131 represents in-office administration of stinging insect venom extracts for two different insect types to treat or prevent allergic reactions. The code captures a common allergist/immunology procedure used to desensitize patients at risk for systemic reactions after stings. Nationally, this service is important due to the prevalence of insect-sting allergy and the role of venom immunotherapy in reducing morbidity and emergency care use.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for venom immunotherapy, common payer coverage considerations, and the types of benchmarks and payment issues typically reported for this service line. The publication also summarizes coding-specific elements relevant to billing staff and revenue cycle teams and highlights typical sites of service and service classification.
This piece is intended for a national audience of clinicians, practice managers, and policy analysts seeking a practical reference for CPT code 95131, including what the code represents, who commonly pays for the service, and what topics to expect in operational and policy discussions about allergen immunotherapy in the outpatient setting.
Billing Code Overview
CPT code 95131 describes administration of stinging insect venom for two types of insects to a patient in the office to treat or prevent an allergic reaction to insect stings. This service involves supervised, in-office injection or immunotherapy using venom extracts intended to reduce sensitivity and prevent systemic or severe local allergic responses.
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Service type: In-office allergen immunotherapy (stinging insect venom), therapeutic/preventive administration
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Typical site of service: Physician office or ambulatory clinic setting
Clinical & Coding Specifications
Clinical Context
A patient with a history of systemic allergic reaction to insect stings presents to an outpatient allergy clinic for supervised office immunotherapy with venom extracts. The typical patient is an adult or child with documented IgE-mediated hypersensitivity to stinging insects (wasp, yellow jacket, hornet, or bee) confirmed by skin testing or specific IgE. During the visit the clinician — commonly an allergist/immunologist — verifies prior reaction history, reviews current medications (especially beta-blockers and ACE inhibitors), obtains informed consent, performs a focused allergy-specific exam, and prepares the appropriate venom extract vials. The provider administers venom extract for two distinct insect types per 95131, monitors the patient in-office for an observation period (typically 30–60 minutes) for local and systemic reactions, documents the lot numbers and doses, and provides post-injection instructions. The typical site of service is an outpatient clinic or physician office with resuscitation equipment available and staff trained in anaphylaxis management. Billing reflects administration of venom for two different insect types given during that encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special circumstances apply |