Basics of CPT code 95145-95170

Codes 95145-95170 represent the antigen itself, its preparation, and the physicians determination of concentration and volume required for the planned schedule of injections based on skin testing and patient history. These codes are used to report the supply of antigen prospectively planned to be administered. (In some cases, the patient may not eventually receive the number of planned doses because of reactions or for other reasons. Regardless, it is appropriate to bill the prospectively planned supply of the antigen at the outset of the scheduled treatment.) The number of doses prepared and provided must be specified when reporting these codes. Administration of injections is not included in these codes.

Description of CPT codes 95145-95170 CPT codes

CPT codes 95145-95170 reports the physician’s preparation of an antigen for allergen immunotherapy and the provision of the antigen extract itself. These codes also include the providing physician’s calculations for the concentration and volume to be used in the dosage based upon the patient’s previous skin test results and personal history. These codes do not, however, include the administration of the allergen therapy. The number of doses must be specified and the vial(s) (series of vials from a treatment board or one multiple dose vial) from which the dose may be drawn is irrelevant. Report the code based on the type of preparation, i.e., the number of different venoms contained in a single administered injection of the extract. CPT code 95145 is reported for a dose containing one single stinging insect venom, CPT code 95146 for an extract containing two single stinging insect venoms, CPT code 95147 for three, CPT code 95148 for four, and CPT code 95149 for five single stinging insect venoms in one dose extract. CPT code 95165 reports single or multiple antigens (not stinging insect), and 95170 is for a whole body extract of a biting insect or other arthropod.

95145 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom
95146 2 single stinging insect venoms
95147 3 single stinging insect venoms
95148 4 single stinging insect venoms
95149 5 single stinging insect venoms

95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)
95170 whole body extract of biting insect or other arthropod (specify number of doses)

CPT codes 95144-95170 Component Billing

• Services for CPT codes 95144-95170 represent a single dose.
• To bill, specify number of doses in the days/units field.
• Use a code below the venom treatment number ONLY for “catch up” purposes.
• If a physician prepares the allergen and administers the injection on the same date of service, bill the appropriate injection code (CPT codes 95115-95117) AND the appropriate preparation code (CPT codes 95145-95170).

CPT Code 95165

• To bill CPT code 95165, designate the number of doses.
• CPT code 95165 does NOT include antigen administration.
• To bill for antigen preparation and administration, use component billing.(Samples below)
• If a multi-dose vial contains less than 10cc, bill the number of 1 cc aliquots that may be removed from the vial up to a maximum of 10 doses per multi-dose vial.
• If medically necessary, physicians may bill for preparation of more than one multi-dose vial.

CPT Code 95170

Applies ONLY to fire ant extract