Summary & Overview
CPT 95199: Unlisted Allergy and Immunology Procedure
Headline: CPT code 95199 defines unlisted allergy/immunology procedures, used when no specific code exists.
Lead: CPT code 95199 is the catch-all CPT code for allergy and immunology services that lack a specific procedural code. It enables clinicians and billing professionals to report novel, atypical, or otherwise unlisted allergy/immunology procedures for national claims processing and coverage review.
Why it matters: Unlisted procedure codes like CPT code 95199 are important for ensuring that emergent or uncommon allergy/immunology services can be billed and adjudicated. They affect claim submission workflows, medical necessity documentation, and payer review processes across major national payers.
Key payers covered: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication outlines the clinical scope of CPT code 95199, how it fits within the allergy/immunology service line, typical sites of service, and implications for documentation and claims review. It highlights benchmarks and policy context relevant to national payers, discusses authorization and medical necessity considerations at a high level, and points to areas where unlisted procedure reporting commonly arises. Data not provided in the input (such as specific modifiers, taxonomies, ICD-10 pairings, and payer-specific rules) are noted as unavailable and are not included.
Billing Code Overview
CPT code 95199 is an unlisted procedure code used to report allergy and immunology services that do not have a specific, assigned CPT code. It is intended for procedures, tests, or clinical services within the allergy/immunology service line that cannot be described by an existing listed code.
Service type: Allergy / Immunology procedures without a specific CPT code
Typical site of service: Allergy or immunology clinics, outpatient physician offices, and other ambulatory care settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a history of severe multiple aeroallergen sensitivities presents to an allergy/immunology clinic for a service not described by an existing CPT code. The patient requires a specialized diagnostic or therapeutic procedure — for example, custom preparation and administration of an investigational allergen extract, complex component-resolved testing not covered by standard panels, or a novel desensitization protocol involving unique dosing schedules and monitoring. The clinical workflow begins with evaluation by an allergist (history, focused exam, review of prior test results), ordering the specialized procedure, obtaining informed consent, preparing individualized materials or protocols in the clinic or laboratory, performing the procedure (which may include monitored administration, serial challenge exposures, or specimen handling), and post-procedure observation with documentation of response and any adverse events. Billing uses 95199 to report the unlisted allergy/immunology procedure; documentation must clearly describe the procedure, time, resources used, and clinical rationale to support medical necessity and to enable payer review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the unlisted procedure requires substantially greater effort or complexity than typical and documentation supports additional work. |