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2025 CPT code 95117

Professional services for allergen immunotherapy; two or more injections.

Office visit codes (99202-99215 etc.) may be used in addition to this code if other identifiable services are provided on the same day, using modifier 25.Medicare requires separate billing for injection and preparation/provision of extracts. Allergy testing and immunotherapy are not usually performed at the same visit.

Modifiers may apply in certain circumstances, such as reduced services (modifier 52), discontinued procedure (modifier 53), or multiple procedures (modifier 99). Consult current CPT guidelines.

Allergen immunotherapy is medically necessary for patients with significant allergic symptoms that are not adequately controlled by other means.Medical necessity should be supported by the patient's medical history, allergy testing results, and documentation of the failure of previous treatments. The decision to initiate or continue immunotherapy should be based on appropriate diagnostic procedures and clinical judgment.

The allergist or immunologist administers the injections, monitors the patient for adverse reactions, and adjusts the dosage regimen based on the patient's response. They are responsible for the overall management of the immunotherapy process, including patient education and ongoing assessment of efficacy and safety.

IMPORTANT:For a single injection, use CPT code 95116.Codes 95120 and 95125 include both extract provision and injection, but Medicare requires separate billing of injection (95115 or 95117) and preparation/provision (94144 or 95165) codes.For supervision of preparation and provision of antigens, see codes 94144 and 95165. Do not use this code with 96372 (subcutaneous/intramuscular injection).

In simple words: This code covers the doctor's services when giving a patient two or more allergy shots at once. The shots contain small amounts of the substance the patient is allergic to, helping them become less sensitive to it over time.The cost of making and supplying the shots themselves is not included in this code.

This CPT code encompasses the professional services rendered during allergen immunotherapy, specifically when two or more injections of allergenic extracts are administered to a patient during a single visit.The code does not include the preparation or supply of the allergenic extracts themselves.Allergen immunotherapy, also known as desensitization or hyposensitization, involves the parenteral administration of allergenic extracts at increasing dosages over time to build tolerance and reduce allergic reactions.This procedure aims to minimize or eliminate allergic responses by gradually introducing the allergen to the patient's system.Appropriate diagnostic procedures and clinical judgment are crucial in determining the suitability of immunotherapy for a patient.

Example 1: A patient with seasonal allergies (pollen) receives two injections of allergenic extracts during a single visit as part of their ongoing immunotherapy regimen., A patient with multiple allergies (pollen, dust mites) receives three injections of different allergenic extracts during a visit, following an established treatment plan., During a maintenance phase of immunotherapy, a patient receives four injections of their established allergenic extracts during a single office visit.

Detailed patient history including allergy testing results,complete list of allergens,dosage of each allergen, date and time of each injection,patient's reaction (if any) to each injection, vital signs before and after each injection,and any medications administered.Physician's notes should document the medical necessity of the procedure.

** Neither this code nor code 95116 covers the preparation and supply of the allergen extracts.For Medicare, always use injection codes (95115 and 95117) and supervision of preparation and provision codes (94144 and 95165).

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