2025 CPT code 95115
(Active) Effective Date: N/A Revision Date: N/A Medicine - Allergen Immunotherapy Injection Allergen Immunotherapy Services and Procedures Feed
Professional services for allergen immunotherapy; single injection, excluding allergen extract provision.
Modifiers may be applicable depending on the circumstances. For example, modifier 25 may be used if a significant, separately identifiable E/M service is performed on the same day as the injection.
Allergen immunotherapy requires proper diagnosis of allergies through appropriate diagnostic testing. Medical necessity is established when a patient exhibits symptoms indicative of a specific allergy, and immunotherapy is determined by the provider to be a suitable and medically appropriate treatment option to alleviate or reduce the impact of those allergic symptoms.
The clinical responsibility lies with the administering physician who is responsible for administering the allergen injection safely and monitoring the patient for any adverse reactions. This includes careful preparation, accurate administration, post-injection observation, and patient education.
In simple words: This code covers the doctor's work in giving you one shot as part of allergy treatment.The shot itself is given by the doctor;the medicine in the shot is provided by someone else, such as another doctor or a pharmacy.
CPT code 95115 represents the professional services rendered for a single allergen immunotherapy injection.This code encompasses the administration of the allergen extract but explicitly excludes the preparation and provision of the extract itself.The service includes the physician's expertise in administering the injection, monitoring the patient's response, and managing any potential reactions.This code is used when the allergenic extract is supplied by a different entity, such as an outside pharmacy or another healthcare provider.
Example 1: A patient presents to their allergist for a single immunotherapy injection. The allergist administers the injection, but the patient had received the extract from a separate pharmacy., A primary care physician, who had not prepared or supplied the extract, administers a single dose of allergen immunotherapy to a patient., An allergist performs skin tests and prepares an allergy extract that they will later administer to the patient in separate visits. The patient returns for a single immunotherapy injection.
Detailed documentation should include the patient's allergy history, the specific allergen administered, the dose administered, the date and time of administration, the physician's observation of the patient's reaction (if any) after the injection, and any required follow-up care.This documentation must justify medical necessity and support the procedure.
** Code 95115 should only be reported when the provider administers the injection but does not provide the allergen extract.If the provider also prepares and provides the allergen extract, a different code (such as 95120 or 95125) may be more appropriate.Always verify payer-specific guidelines before submitting claims.
- Revenue Code: M1B (Office Visits - Established)
- RVU: The RVUs for this code vary based on geographic location and other factors. Consult your local Medicare payment system for the precise RVU values and reimbursement rates.
- Global Days: This code lacks a global surgical period as it's not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not apply to this code.
- Fee Schedule: Historical fee schedule data is not available here. To obtain this information consult fee schedules or databases that track historical medical billing rates.
- Specialties:Allergists/Immunologists, Family Medicine, Internal Medicine
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center