Summary & Overview
CPT 95146: Mixing Two Stinging Insect Venom Extracts
CPT code 95146 covers the mixing and preparation of a specified number of doses of extract from two single stinging insect venoms. The code captures a discrete preparatory service that supports venom immunotherapy, a clinically important intervention for patients with IgE-mediated hypersensitivity to stinging insects. Nationally, accurate reporting of this code informs payment, quality measurement, and tracking of allergen-immunotherapy utilization.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, plus what to expect in benchmarking and policy considerations relevant to billing and coverage. The publication outlines how 95146 fits into the allergen immunotherapy workflow, identifies common billing and coverage patterns across major payers, and highlights operational implications for allergy practices and outpatient clinics.
The analysis provides benchmarks where available, notes recent policy updates affecting preparation and billing of allergen extracts, and summarizes coding considerations tied to service delivery. Data not available in the input is identified as such; the focus remains on national relevance rather than state-specific guidance.
Billing Code Overview
CPT code 95146 describes the preparation and mixing of a specified number of doses of extract from two single stinging insect venoms. This service is typically performed by a provider responsible for compounding allergen extracts for immunotherapy.
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Service type: Allergen extract preparation and compounding for venom immunotherapy
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Typical site of service: Allergy clinic, physician office, or outpatient infusion/administration setting
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a documented history of immediate hypersensitivity reactions to stinging insect venom presents to an allergy clinic to initiate venom immunotherapy. The allergist prepares individualized venom extract doses for subcutaneous injection. The clinical workflow includes verification of prior allergy testing (skin test or specific IgE), determination of maintenance or incremental dosing schedule, retrieval of two specified single stinging insect venom extracts from pharmacy stock, sterile mixing and dilution according to manufacturer and clinic protocol, labeling of prepared syringes or vials with patient identifiers and concentration, and documentation of lot numbers and expiration dates in the medical record. The provider performs and documents the preparation step described by 95146 (mixes and prepares a specified number of doses of extract of two single stinging insect venoms). The typical site of service is an outpatient allergy/immunology clinic or hospital-based outpatient clinic with on-site medication preparation and observation capability. The typical patient scenario includes observation for 30–60 minutes post-injection for signs of systemic reaction and readiness for dose escalation or maintenance as per immunotherapy protocol.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified claim | Use when no modifier is required and service is billed normally. |