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 |
| 26 | Professional component | Use when reporting only the physician component of a split service (rare for immunotherapy administration when facility bills technical component) |
| 51 | Multiple procedures | Use when multiple distinct procedures are billed the same day and carrier requires modifier to denote multiple services |
| 52 | Reduced services | Use when venom administration is partially reduced or discontinued for clinical reasons |
| 53 | Discontinued procedure | Use when administration is begun but stopped due to patient adverse reaction or safety concern |
| 55 | Postoperative management only | Generally not applicable but included when only follow-up management is billed by a provider separate from the administering clinician |
| 62 | Two surgeons | Rarely applicable; use when two physicians of different specialties share responsibility for care during the visit |
| 80 | Assistant surgeon | Not typically used for immunotherapy administration but used when an assistant surgeon participates |
| 82 | Assistant surgeon (when qualified resident not available) | Similar to 80, used if an assistant is required and no resident is available |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not typical for injections but used if advanced practitioner documents and bills under applicable rules |
| QK | Medical direction by a physician; more than four concurrent anesthesia procedures | Not applicable to immunotherapy; included only if anesthesia services are involved |
| QX | CRNA service: medically directed by anesthesiologist | Not applicable unless anesthesia care is provided during administration |
| QY | Anesthesiologist assistant | Not applicable unless anesthesia services are provided |
| TC | Technical component | Use when billing only the technical component (e.g., facility or equipment) if split billing applies |
| FY | Service furnished under a Federal health care program; paid under a fee schedule differerence | Rarely used; apply per payer policy when relevant |
| Taxonomy Code | Specialty | Notes |
|---|
207K00000X | Allergy & Immunology | Board-certified allergists who typically manage venom immunotherapy |
| 207Q00000X | Family Medicine | Family physicians who provide office-based immunotherapy in some practices |
| 208000000X | Internal Medicine | Internists with allergy training who may administer venom immunotherapy |
| 363A00000X | Physician Assistant | PAs who administer injections under physician supervision per state rules |
| 367A00000X | Nurse Practitioner | NPs who administer and document venom immunotherapy under applicable supervision rules |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
T63.441A | Contact with wasp venom causing local adverse effect, initial encounter | Wasp venom allergy is a common indication for venom immunotherapy |
| T63.441D | Contact with wasp venom causing local adverse effect, subsequent encounter | Follow-up encounters after initial reactions or treatments |
| T78.2XXA | Anaphylactic shock, unspecified, initial encounter | Systemic anaphylaxis to insect sting indicates need for venom immunotherapy to prevent recurrence |
| T78.2XXD | Anaphylactic shock, unspecified, subsequent encounter | Subsequent encounter documentation for ongoing management and immunotherapy response |
| T78.40XA | Allergy, unspecified, initial encounter | General allergic reaction documentation when specific venom code not used |
| Z88.0 | Allergy status to bee venom | Documented allergy history used to justify venom immunotherapy |
| Z91.010 | Allergy to food (if multiple allergies present) | Captures allergy history; relevant when evaluating overall allergic risk profile |
| J45.909 | Unspecified asthma, uncomplicated | Asthma is an important comorbidity to document because uncontrolled asthma increases risk during immunotherapy |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
95115 | Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection | Used for single-allergen immunotherapy injections; may be billed on days when single-allergen dosing is given instead of multi-insect venom under 95134 |
| 95117 | Professional services for allergen immunotherapy not including provision of allergenic extracts; two or more injections | Used when multiple different allergen injections are given in the same visit and not covered by venom-specific code |
| 95144 | Antigen administration by inhalation; initial | May be performed in allergy practice for inhalant immunotherapy; distinct from venom administration |
| 36415 | Collection of venous blood by venipuncture | Performed prior to immunotherapy for serum venom-specific IgE testing or baseline labs |
| 95180 | Allergen immunotherapy with allergenic extract (provision of extract) | Used when billing separately for provision/preparation of allergenic extracts if payer requires separate coding |
| 99354 | Prolonged service in the office by physician; face-to-face beyond usual service (first hour) | May apply if prolonged observation or counseling beyond usual monitoring time is documented following venom administration |