Ingestion Challenge Testing

 95076 is a time-driven code to cover the first 120 minutes of an ingestion challenge. This time is testing time – not face-to-face time. Code 95079 is for each additional 60 minutes of testing time. Included in the testing time is the assessment of the patient and monitoring of the patient’s activities for an allergic reaction, including the time afterthe last dose has been administered and appropriate counseling of test results and what to do if a delayed reaction occurs. The pre-test and intra-test period may include blood pressure monitoring, and/ or peak flow meter testing. Interventional therapy is reported as a separate service if intervention is necessary due to the patient’s medical condition. The challenge immediately ends if an intervention is used and no further doses are given to the patient. Testing time does not include the time for evaluation and management, and time must be documented to support the use of these codes. The first hour of testing time (95076) is reportable after the first 61 minutes of this pre-test, intra-test, and post-test period has occurred. Code 95079 is reportable for an additional hour of testing time, and must include at least 31 minutes extra. 95079 is not to be coded as a stand-alone code, but rather as an “add on” code to 95076. The “+” in front of the code indicatesthe code is an “add-on” code to the base code 95076. 95079 may be charged again more than once per challenge as an add-on code for each additional hour of testing

Allergen Immunotherapy Codes. Allergen injection codes are usually 95115 for one injection and 95117 for two or more injections. The 95120 and the 95125 codes cover the injection plus the antigen.

They do not have an RVU and are not recognized by the CMS. The codes 95130-95134 are for injection and provision of stinging insect venom. These codes also do not have an RVU for the CMS. The number of stinging insects determines the appropriate code whether you are using codes 95130-95134 or 95145- 95149. Codes 95145-95149 are for the provision of stinging insect venom(s) separate from the injection, and the total number of stinging insect venoms in the dose determines the appropriate code. For example, mixed vespid venom would be coded with 95147, whereas both mixed vespid and honeybee venoms would be coded with 95148.

The provision of a single-dose vial is code 95144, which is most commonly used when a patient needs to take a single dose for a specific time frame or purpose.

Currently, there are two definitions of the code 95165 − the CPT definition and the CMS definition. CPT defines the 95165 code as the amount of antigen(s) administered in a single injection from a multiple-dose vial. CME defines the 95165 code as a 1-cc aliquot from a single multiple-dose vial. Diluted doses are not billable according to the CMS definition. If you are mixing a “set” for a Medicare patient, you will charge only for the vial that is designated as the maintenance vial. If you “dilute down,” the diluted doses are not billable to Medicare. Medicare also requires you to provide the first dose prior to billing for the number of anticipated doses (1-cc each) the patient will receive.

For a non-Medicare patient, you would charge for all of the doses in the set according to the number of anticipated doses you expect the patient to receive. When the patient needs a refill on immunotherapy solution, for a Medicare patient, billing would be for the number of ccs. provided,;and for a non-Medicare patient, the number of doses anticipated. The CPT code does not define a maximum number of doses, although individual carriers may have a maximum number of doses allowed per patient, either per calendar year or per billing.

Code 95170 is for desensitization to biting insects, such as fire ants. Rapid desensitization is coded as 95180, and is per hour of treatment time. It requires that time be documented to support the code. Some allergists are providing these services in their office. The 95180 code does not include the provision of antigens used in rapid desensitization, but does include the injections during the period of time desensitization is occurring. 

Code 95199 is the unlisted procedure code to be used for those services not described by another code in the allergy immunology section. When submitting an unlisted procedure code to a payer, send supporting documentation for the services as well as the fees charged. For these services, it would be advised that the allergist have the patient sign a waiver to indicate the patient may be responsible for the services or procedure if the patient’s insurance does not cover them.