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

CPT 95165 is payable for physician preparation and provision of non-venom antigen extracts when an MD/DO has examined the patient and established a treatment plan and dosage regimen; injection/administration is billed separately (e.g., CPT 95115/95117). Billing is limited to the PE-supported number of doses (generally up to 10 doses per 10 cc vial or proportional to vial cc when <10 cc), a reasonable supply is limited to a 12-month supply at one time, and maintenance claims must include modifier EJ; visits on the same day as injections are billable only if a separately identifiable service is documented.

"CPT 95165 may be billed for the physician's preparation and provision of antigens (non-venom) for allergen immunotherapy when the physician prepares antigen extracts for a specific patient."

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