CPT® Code 95130

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 stinging insect venom

Common Language Description

Allergen immunotherapy is a medical treatment designed to alleviate allergic reactions caused by stinging insects, such as bees, wasps, hornets, and yellow jackets. This therapy is particularly beneficial for individuals who have experienced severe allergic reactions, including anaphylaxis, to these insect stings. The process begins with allergy testing, which is performed separately to identify the specific allergens responsible for the patient's reactions. Once the allergens are 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, gradually increasing doses of the allergenic extract, typically administered via injection into the upper arm. This phase usually occurs one to three times a week and lasts for approximately 3 to 6 months. Following this, the maintenance phase commences, where patients receive monthly injections of the allergenic extract for a duration of 3 to 5 years. The allergenic extract used in this therapy is prepared and provided by the prescribing physician or another qualified healthcare professional. For billing purposes, CPT® Code 95130 is utilized for the injection of a single stinging insect venom extract, while additional codes are available for multiple venoms, allowing for accurate coding based on the number of allergens treated.

1. Indications

Allergen immunotherapy is indicated for patients who exhibit allergic reactions to stinging insects, which may include a range of symptoms from mild local reactions to severe systemic responses such as anaphylaxis. The following conditions warrant the use of allergen immunotherapy:

Severe Allergic Reactions: Patients who have experienced significant allergic reactions to stinging insect venoms, including anaphylaxis, are prime candidates for this therapy.
Positive Allergy Testing: Individuals who have undergone allergy testing that confirms sensitivity to specific stinging insect venoms are eligible for treatment.
History of Recurrent Reactions: Patients with a documented history of recurrent allergic reactions to stings from bees, wasps, hornets, or yellow jackets may benefit from immunotherapy to reduce the risk of future reactions.

2. Procedure

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

Step 1: Allergy Testing - Prior to initiating immunotherapy, patients undergo allergy testing to identify specific stinging insect allergens. This testing is crucial for determining the appropriate allergenic extract to be used in the immunotherapy regimen.
Step 2: Development of Immunotherapy Schedule - Based on the results of the allergy testing, a personalized immunotherapy schedule is created. This schedule includes the build-up phase and the maintenance phase, tailored to the patient's specific needs.
Step 3: Administration of Allergenic Extract - During the build-up phase, the patient receives injections of the allergenic extract. These injections are typically administered into the upper arm and occur one to three times a week, with doses gradually increasing over time. This phase generally lasts between 3 to 6 months.
Step 4: Transition to Maintenance Phase - After the build-up phase, the patient transitions to the maintenance phase, which involves monthly injections of the allergenic extract. This phase continues for a period of 3 to 5 years, providing long-term protection against allergic reactions to stinging insect venoms.

3. Post-Procedure

Post-procedure care for patients undergoing allergen immunotherapy includes monitoring for any immediate adverse reactions following the injection, particularly during the initial build-up phase when the risk of reactions may be higher. Patients are typically advised to remain in the office for a short period after receiving their injection to ensure they do not experience any severe allergic responses. Additionally, patients should be educated on recognizing signs of an allergic reaction and the importance of adhering to their scheduled injections. Regular follow-up appointments are essential to assess the patient's response to therapy and make any necessary adjustments to the treatment plan. Overall, the goal of post-procedure care is to ensure patient safety and the effectiveness of the immunotherapy regimen.

Short Descr	IMMNTX 1 STING INSECT
Medium Descr	PROF SVCS ALLG IMMNTX W/PRV XTRC 1 STING INSECT
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 stinging insect venom
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