What Is CPT Code 95117 for Allergen Immunotherapy?
Understand the specific CPT code for a common allergy treatment. Learn its application in clinical settings and the documentation needed for compliance.
Current Procedural Terminology (CPT) codes are standardized medical codes used by healthcare professionals to report medical, surgical, and diagnostic procedures and services. These codes provide a uniform language for describing medical services, essential for accurate communication between healthcare providers and insurance payers. The American Medical Association (AMA) develops and maintains the CPT code set, used to streamline reporting, billing, and administration in healthcare. CPT codes ensure services are consistently identified.
Defining CPT Code 95117
CPT code 95117 represents “Professional services for allergen immunotherapy; single injection.” Allergen immunotherapy, often known as allergy shots or desensitization, is a medical treatment designed to build tolerance to specific allergens that trigger allergic symptoms. This therapy involves exposing individuals to gradually increasing amounts of allergens to modify the immune system’s response.
The “professional services” aspect of CPT code 95117 refers to the direct involvement of a physician or other qualified healthcare professional in the patient’s assessment, supervision, and administration of the injection. The “single injection” component indicates it is used to report the administration of one injection. CPT code 95117 does not include the preparation of the allergen extract, which is billed separately. Services generally included encompass the administration of the injection and immediate post-injection observation for any adverse reactions.
Clinical Use of Code 95117
CPT code 95117 is used in clinical settings when patients receive allergen immunotherapy injections, typically administered by qualified healthcare professionals under supervision. This code is applicable for ongoing allergy treatment, particularly during the maintenance phase where patients receive regular injections to sustain their desensitization. The treatment progresses from a build-up phase with increasing doses to a maintenance phase, which can last for several years.
This code is for the administration of the injection and is distinct from initial allergy testing or the preparation of allergen extracts. Medical necessity is a requirement for CPT code 95117. A physician’s order is essential, and the treatment should be indicated for patients with allergic rhinitis, allergic asthma, or stinging insect hypersensitivity that cannot be adequately managed by medications or avoidance.
Essential Billing and Documentation
Accurate billing for CPT code 95117 requires comprehensive documentation within the patient’s medical record. This documentation must support the medical necessity of each service. Patient records should include demographic information, a detailed allergy history, and the diagnosis that led to the prescribed immunotherapy.
A documented treatment plan for allergen immunotherapy is crucial, specifying the types of allergens, prescribed dosages, and the frequency of injections. For each administration of CPT code 95117, specific details must be recorded in an injection log or similar record. This includes the date of service, the specific allergens administered, the dosage volume and strength, the site of injection, and any patient reactions observed immediately post-injection. The credentials and identification of the healthcare professional administering the service should also be clearly noted.