CPT® Code 95120

Official Description

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection

Common Language Description

Allergen immunotherapy, commonly referred to as allergy shots, is a medical treatment designed to alleviate symptoms associated with allergic reactions. This procedure is particularly effective for individuals suffering from seasonal allergies, such as those triggered by pollen from grasses, weeds, and trees, as well as indoor allergies caused by dust mites, pet dander, and molds. The process begins with allergy testing, which is a separate and reportable service, to identify the specific allergens that provoke the patient's symptoms. Once the allergens are identified, a tailored immunotherapy schedule is established, which consists of two distinct phases: the build-up phase and the maintenance phase. During the build-up phase, patients receive small but progressively increasing doses of the allergenic extract(s) through injections, typically administered in the upper arm, on a frequency of one to three times per week. This phase generally lasts between three to six months. Following the build-up phase, patients transition to the maintenance phase, where they receive monthly injections for an extended period, usually ranging from three to five years. The allergenic extract used in this therapy is prepared and provided by the physician or another qualified healthcare professional. For billing purposes, CPT® Code 95120 is utilized for a single injection during an encounter, while CPT® Code 95125 is designated for encounters where two or more injections are administered.

1. Indications

Allergen immunotherapy is indicated for patients experiencing allergic reactions due to specific allergens. The following conditions are commonly treated with this procedure:

Seasonal Allergies Allergies triggered by pollen from grasses, weeds, and trees.
Indoor Allergies Allergies caused by dust mites, pet dander, and molds.

2. Procedure

The procedure for allergen immunotherapy involves several key steps that ensure the safe and effective administration of allergenic extracts. The following outlines the procedural steps:

Step 1: Allergy Testing Prior to initiating immunotherapy, patients undergo allergy testing to identify specific allergens that trigger their symptoms. This testing is crucial for developing a personalized treatment plan.
Step 2: Development of Immunotherapy Schedule Based on the results of the allergy testing, a customized immunotherapy schedule is created. This schedule includes two phases: the build-up phase and the maintenance phase.
Step 3: Build-Up Phase During this initial phase, patients receive small doses of the allergenic extract(s) through injections, typically administered in the upper arm. The dosage is gradually increased over time, with injections occurring one, two, or three times a week. This phase usually lasts for three to six months.
Step 4: Maintenance Phase After the build-up phase, patients transition to the maintenance phase, where they receive monthly injections of the allergenic extract for a duration of three to five years. This phase is designed to maintain the therapeutic effects of the immunotherapy.
Step 5: Provision of Allergenic Extract The allergenic extract used in the immunotherapy is prepared and provided by the physician or other qualified healthcare professional, ensuring that the patient receives the appropriate treatment.

3. Post-Procedure

After the administration of allergen immunotherapy, patients are typically monitored for any immediate adverse reactions, which may include localized swelling or redness at the injection site. It is important for patients to report any unusual symptoms to their healthcare provider. The expected recovery period is generally straightforward, as most patients can resume normal activities shortly after the injection. Ongoing follow-up appointments are essential to assess the effectiveness of the therapy and make any necessary adjustments to the treatment plan. Additionally, patients should be educated on the importance of adhering to the scheduled injections to achieve optimal results from the immunotherapy.

Short Descr	IMMUNOTHERAPY ONE INJECTION
Medium Descr	PROF SVCS ALLG IMMNTX W/PRV ALLGIC XTRC 1 NJX
Long Descr	Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection
Status Code	Not Valid for Medicare Purposes
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	9 - Not Applicable
Multiple Procedures (51)	9 - Concept does not apply.
Bilateral Surgery (50)	9 - Concept does not apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	9 - Concept does not apply.
Co-Surgeons (62)	9 - Concept does not apply.
Team Surgery (66)	9 - Concept does not apply.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Non-Covered Service, not paid under OPPS
Type of Service (TOS)	1 - Medical Care
Berenson-Eggers TOS (BETOS)	M5D - Specialist - other
MUE	0
CCS Clinical Classification	228 - Prophylactic vaccinations and inoculations

GZ	Item or service expected to be denied as not reasonable and necessary
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