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Allergen immunotherapy, commonly referred to as allergy shots, is a medical treatment designed to alleviate symptoms associated with allergic reactions. This therapy is particularly effective for individuals suffering from seasonal allergies, such as those triggered by pollen from various plants, including grasses, weeds, and trees. Additionally, it addresses indoor perennial allergies, which may arise from common allergens like dust mites, pet dander, and molds. The process of allergen immunotherapy begins with allergy testing, which is conducted to pinpoint the specific allergens affecting the patient. Once identified, a tailored immunotherapy schedule is established, consisting of two distinct phases: the build-up phase and the maintenance phase. During the build-up phase, patients receive small doses of the allergenic extract(s) through injections, typically administered in the upper arm. These injections are given one to three times a week and usually span a duration of 3 to 6 months. The goal of this phase is to gradually increase the patient's tolerance to the allergens. Following the build-up phase, patients transition to the maintenance phase, which involves monthly injections over a period of 3 to 5 years. It is important to note that while the allergenic extracts are formulated and provided by an allergist or an outside supplier, the administration of these extracts is performed by another physician or qualified healthcare professional. After each injection, the patient is monitored for a specific period to ensure safety and manage any potential reactions. For billing purposes, CPT® Code 95115 is utilized for a single injection, while CPT® Code 95117 is designated for encounters involving two or more injections.
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The procedure of allergen immunotherapy is indicated for patients experiencing allergic reactions due to specific allergens. The following conditions are explicitly recognized as indications for this treatment:
The procedure for allergen immunotherapy involves several critical steps that ensure the effective administration of the treatment. Each step is designed to maximize patient safety and therapeutic efficacy.
After the administration of allergen immunotherapy, patients are typically monitored for a designated period to ensure they do not experience any immediate adverse reactions. It is essential for healthcare professionals to observe patients closely during this time. Patients may be advised to report any unusual symptoms or reactions that occur after the injection. The expected recovery period varies, but many patients can resume their normal activities shortly after the procedure. Long-term follow-up is also important to assess the effectiveness of the therapy and make any necessary adjustments to the treatment plan. Regular communication between the patient and healthcare provider is encouraged to optimize the outcomes of allergen immunotherapy.
| Short Descr | IMMUNOTHERAPY INJECTIONS | Medium Descr | PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS | Long Descr | Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M1B - Office visits - established | MUE | 1 | CCS Clinical Classification | 228 - Prophylactic vaccinations and inoculations |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | GA | Waiver of liability statement issued as required by payer policy, individual case | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | CR | Catastrophe/disaster related | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | SA | Nurse practitioner rendering service in collaboration with a physician | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GZ | Item or service expected to be denied as not reasonable and necessary | GW | Service not related to the hospice patient's terminal condition | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | EJ | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | AY | Item or service furnished to an esrd patient that is not for the treatment of esrd | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | JW | Drug amount discarded/not administered to any patient | JZ | Zero drug amount discarded/not administered to any patient | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q8 | Two class b findings | T6 | Right foot, second digit | TD | Rn | U7 | Medicaid level of care 7, as defined by each state | UD | Medicaid level of care 13, as defined by each state |
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| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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