2025 CPT code 95199
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Allergy and Immunology - Allergy and Clinical Immunology Procedures Medicine Services and Procedures Feed
Unlisted allergy/clinical immunologic service or procedure.
Modifiers may be applicable depending on the specific circumstances and the additional services performed (e.g., modifier 25 if a significant, separately identifiable E/M service is performed).
Medical necessity is established by documenting that the procedure performed was necessary to diagnose or treat the patient's condition, that no other CPT codes appropriately describe the procedure, and that the procedure was performed according to established medical standards.
The physician or qualified healthcare professional performs a unique allergy or immunology procedure not covered by existing CPT codes.This includes the complete process, from assessment and planning to execution and follow-up.
In simple words: This code is for allergy or immune system tests or treatments that don't have their own specific code.If your doctor does something unusual, they use this code and explain it fully to your insurance company to get paid.
This CPT code is used to report allergy or immunology services or procedures that do not have a specific CPT code.It should only be used when no other appropriate code exists and requires detailed documentation supporting medical necessity and the distinct nature of the service performed, justifying its unlisted status.The service must be clearly differentiated from other established CPT codes to avoid denial of payment.
Example 1: A patient presents with a severe, unusual allergic reaction to a novel medication not previously documented in medical literature. The physician performs extensive testing and develops a unique desensitization protocol, billing 95199 to account for the customized approach., A patient experiences an allergic reaction to a combination of environmental allergens that is too complex for standard allergy testing.The physician uses 95199 to bill for a specialized test developed to isolate the specific allergens causing the reaction., A patient needs a customized immunotherapy regimen.The physician prepares a specific allergenic extract not commercially available, using this code to bill for the preparation and administration of the unique solution.
Detailed description of the performed procedure, including rationale, materials, techniques, and time spent. Justification for using 95199 instead of a specific code. Comparison to similar procedures with their respective CPT codes.Complete patient history, including allergy testing results and relevant medical history.Operative notes or procedural records.Patient's response to the procedure.Copies of any unique materials used.
** Due to the nature of this unlisted code, thorough and precise documentation is essential to prevent claim denials.Pre-authorization or verification of benefits with the payer before performing the service is strongly recommended.Payment is highly dependent on the payer’s interpretation of the documentation and their internal policies.
- Revenue Code: T2D (Other Tests - Other)
- RVU: Unknown. RVUs vary based on payer and geographic location. Payment is determined on a case-by-case basis, heavily relying on detailed documentation of the procedure.
- Global Days: Not applicable. This is an unlisted code and does not apply to global surgical periods.
- Payment Status: Active, but payment depends heavily on documentation and payer-specific policies.
- Modifier TC rule: Not applicable for this unlisted procedure.
- Fee Schedule: Historical fee schedules vary significantly by payer and location.Detailed documentation is crucial for establishing appropriate payment.
- Specialties:Allergy and Immunology, Internal Medicine, Pediatrics
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center