Summary & Overview
CPT 95170: Insect/Arthropod Whole Body Allergen Extract Preparation
CPT code 95170 covers the mixing and preparation of whole body extracts from biting insects or other arthropods for use as allergenic material. Nationally, this code captures a specialized laboratory and clinical service within allergy/immunology practice that supports diagnostic skin testing and desensitization therapies. Proper coding affects clinical workflows, inventory control, and payment for compounding allergen extracts.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses how the code is used across outpatient allergy clinics and physician offices, and how payers typically recognize and reimburse for allergen extract preparation services.
Readers will learn the clinical context for use of 95170, the typical sites of service, and what to expect from payer coverage nationally. The publication summarizes benchmark considerations, relevant policy updates affecting allergen extract compounding, and operational implications for allergy practices. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 95170 describes the provider mixing and preparing a specified number of doses of whole body extract of a biting insect or other arthropod. This service involves compounding allergenic extracts intended for diagnostic or therapeutic use.
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Service type: Allergen extract preparation and compounding
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Typical site of service: Allergy clinic, physician office, or outpatient infusion/administration area where allergen extracts are prepared and handled
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Clinical & Coding Specifications
Clinical Context
A patient with recurrent or seasonal allergic reactions to insect bites is scheduled for immunotherapy with whole body insect extract. Typical patient: a 34-year-old outdoor worker with history of systemic large local reactions and recurrent urticaria following Hymenoptera stings who is receiving venom immunotherapy. The allergy/immunology clinic visit begins with review of prior testing and determination of required extract concentration and number of doses. The provider mixes and prepares a specified number of whole body insect or arthropod extract doses (venom or whole-body extract) according to standard dilution protocols, labels syringes/vials, documents lot numbers and expiration dates, and hands prepared doses to nursing for administration or for patient self-injection teaching. The service is commonly performed in an ambulatory clinic or hospital outpatient infusion center, with documentation of indication, extract type, number of doses prepared, concentrations, and any special handling (refrigeration, preservative). Billing uses 95170 for the provider preparation of the specified number of doses of whole body insect/arthropod extract; administration, monitoring, and any separate services (e.g., intradermal testing, office visit) are coded separately.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default; no special reporting circumstances |