Billing for venom testing and immunotherapy

As we noted in last week’s Insider, there continues to be concerns about pricing and adequate availability of venoms for testing and treatment. We also understand that for Medicare, Medicaid, and some other plans, it is sometimes at a near break-even proposition to provide these services. We thought it would be timely to review the coding for both venom testing and immunotherapy.

Venom testing

When billing for venom testing, whether subcutaneous or intracutaneous, use CPT Code 95017. The number of tests should be specified in the Unit Box on the claim form or field. The Medicare and Medicaid MUE is 27, so billing for tests in excess of this number may result in denials.

Venom immunotherapy

Venom immunotherapy is billed using CPT Codes 95145 – 95149 depending on the number of different venoms the patient is receiving. For one venom use 95145; two venoms use 95146; use 95147 for the three-vespid mix; 95148 if a patient is receiving the three-vespid mix and another single venom; and 95149 if receiving the three-vespid mix plus two additional venoms. Venom immunotherapy is billed based on the number of doses. A dose for this purpose is the total amount of venom delivered during an encounter.

For example, if a patient is on four-venom therapy and receives one injection from a vial containing the three-vespid mix and another from a vial containing wasp, this would be one dose of 95148 even though it came from two separate vials. The Medicare and Medicaid MUEs for the venom immunotherapy codes is 10.

In addition, you may still bill the allergy injection codes for administering the injections. One unit of 95115 for a single shot or one unit of 95117 for two or more injections.

Advocacy Issue: 
Billing, Coding & Payments
Extracts