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

CPT 95165 (preparation/provision of non-venom allergen extracts) is payable when an MD/DO has examined the patient, documented a treatment plan, and specified the number of doses; injections (CPT 95115/95117) are billed separately. Billing for vial preparation is limited to the number of 1 cc aliquots (generally up to 10 doses per 10 cc vial, prorated for partial vials, and equal to vial cc volume for larger vials), and a reasonable supply is typically limited to a 12-month supply. Maintenance therapy claims require modifier EJ, and clear documentation of patient identifiers, preparer, extract composition, volumes, lot numbers, and expiration dates must be maintained.

"CPT 95165 is covered for professional preparation and provision of non-venom allergen antigen extracts when the number of doses is specified and the code is reported based on the type of antigen(s)..."