2025 CPT code 95170
(Active) Effective Date: N/A Revision Date: N/A Allergy and Clinical Immunology Procedures - Provision of Antigens Allergen Immunotherapy Services and Procedures Feed
Professional services for preparing a specified number of doses of whole body extract of a biting insect or other arthropod for allergen immunotherapy.
Modifiers 52 (reduced services), 53 (discontinued procedure), 76 (repeat procedure by same physician), 77 (repeat procedure by another physician), and others may apply depending on the circumstances. Consult the current CPT codebook for specific modifier application rules.
Medical necessity for allergen immunotherapy is established based on a comprehensive allergy evaluation demonstrating significant hypersensitivity to specific allergens that impact the patient's quality of life or pose a significant health risk. Documentation must support the diagnosis and the need for allergen immunotherapy to manage the allergic condition effectively.
The allergist or immunologist is responsible for preparing the allergen extract.This involves careful extraction, purification, and concentration to ensure safety and efficacy while maintaining the allergen's potency.The preparation must be precisely documented to ensure proper treatment and billing.
- Allergen Immunotherapy Services and Procedures
- Allergy and Clinical Immunology Procedures > Allergen Immunotherapy Services and Procedures
In simple words: This code covers the work done by a doctor to prepare allergy shots from a stinging insect or similar creature. The doctor prepares a certain number of shots, which are then given to the patient as part of allergy treatment. The code doesn't include actually giving the patient the shots.
CPT code 95170 represents the professional services involved in the preparation of a specified number of doses of whole body extract from a biting insect or other arthropod. This extract is specifically for use in allergen immunotherapy, a treatment designed to desensitize patients to specific allergens. The preparation process includes the extraction, purification, and preparation of the allergen extract for safe and effective administration through injection.This code does not encompass the actual administration of the prepared extract. The number of doses prepared must be specified for accurate billing.
Example 1: A patient presents with a history of severe fire ant stings. The allergist prepares 10 doses of fire ant extract for subcutaneous immunotherapy. The allergist uses code 95170 to bill for the preparation of the extract. The patient's subsequent injections are billed using code 95115 or 95117., A patient with a history of multiple insect bites (not specifically fire ants) requires allergen immunotherapy. The allergist extracts, purifies, and prepares a total of 5 doses of a whole-body arthropod extract. The allergist bills using code 95170, specifying the number of doses prepared. The administration of the injections will be separately billed., An allergist prepares a single-dose vial of fire ant extract and administers the injection to the patient on the same day. The allergist bills for both antigen preparation using code 95170 (with a quantity of 1) and injection using code 95115.
Detailed documentation must include the patient's allergy history, the type of insect or arthropod from which the extract was derived, the number of doses prepared, the method of preparation, and any relevant dilutions or concentrations.All preparation and administration details must be accurately documented.
** For Medicare, this code is only payable in the office and outpatient hospital settings.The payer's specific guidelines should be consulted to ensure compliance with all requirements for billing and reimbursement.
- Revenue Code: M5D (Specialist - Other)
- RVU: RVUs vary based on geographical location and payer. Consult the relevant fee schedule for specific values.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Fee schedules vary by payer and location.Consult your payer's fee schedule for historical and current rates.
- Specialties:Allergy and Immunology
- Place of Service:Office, Outpatient Hospital (on-campus/off-campus)