Summary & Overview
CPT 95134: Office Administration of Venom Immunotherapy for Insect Stings
CPT code 95134 designates the provider-administered injection of stinging insect venom extracts for up to five different insect venoms in an office setting to treat or prevent allergic reactions. Venom immunotherapy is a clinically important intervention because it reduces the risk of systemic allergic reactions to insect stings and can be life-saving for highly sensitized individuals. Nationally, accurate coding of venom immunotherapy affects clinical workflows, utilization monitoring, and payer coverage determinations for allergy services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for venom immunotherapy, typical sites of service, and common administrative considerations for billing this service. The publication outlines benchmarks for service utilization where available, summarizes relevant policy and coverage themes that influence reimbursement and authorization, and highlights documentation elements that support appropriate use of CPT code 95134.
This resource is intended for payers, billing professionals, and clinical administrators seeking a national perspective on coding and administrative implications for office-based venom immunotherapy for insect stings. Data not available in the input will be noted as such in detailed sections.
Billing Code Overview
CPT code 95134 describes the in-office administration of stinging insect venom extracts for up to five distinct insect venoms to treat or prevent allergic reactions in sensitized patients. The service involves supervised, provider-administered venom immunotherapy delivered during a clinical visit.
-
Service type: Allergy immunotherapy administration (venom immunotherapy)
-
Typical site of service: Ambulatory clinic or physician office setting where allergy injections and observation can be provided
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a documented systemic allergic reaction to hymenoptera stings presents to an allergy/immunology clinic for venom immunotherapy. The patient reports prior anaphylaxis after a wasp sting and has positive venom-specific IgE testing and/or skin testing. In-office workflow begins with informed consent, review of prior reactions and medications, baseline vital signs and peak flow if indicated, and assessment for contraindications (e.g., uncontrolled asthma, beta-blocker therapy). The provider prepares standardized venom extract vials for the five insect types covered under the code, confirms dose and schedule, and administers the injection(s) intramuscularly or subcutaneously per protocol. The patient is monitored in the office for an observation period (typically 30 minutes) for immediate hypersensitivity; vital signs and symptom checks are documented. Any acute reactions are treated per anaphylaxis protocols. Billing is submitted using 95134 to reflect administration of stinging insect venom extracts for up to five insect types in the office setting. Typical site of service is an outpatient allergy/immunology clinic or physician office. Typical providers include board-certified allergists/immunologists, family medicine physicians with allergy training, and physician assistants or nurse practitioners working under supervision.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no special circumstances apply |