Billing and Coding: Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

Code 95165 covers physician preparation and provision of non-venom allergen antigens when an MD/DO has examined the patient and established a treatment plan and dosage regimen; administration/injection is billed separately. Billing is limited by vial volume (bill up to the number of 1 cc aliquots per vial, typically max 10 doses per 10 cc vial unless larger vials are prepared), a reasonable supply is limited to 12 months, and maintenance immunotherapy claims must include modifier EJ; same-day visits and injection services should only be billed together if the visit is separately identifiable.

"Medicare payment is allowed for preparation/provision of antigens (code 95165) when a physician (MD or DO) prepares the antigen, has examined the patient, and has determined a treatment plan and do..."

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