Inquiries regarding the use of CPT 95180 (rapid desensitization procedure) for food oral immunotherapy (OIT), including peanut OIT (Palforzia®) and food-based protocols, have recently been submitted to the College.
To provide clarification, the official joint ACAAI/AAAAI guidance issued in 2021 remains unchanged:
- There is no CPT code specifically created for food OIT.
- CPT 95180 is NOT recommended for food OIT. This code is intended for injected rapid desensitization (e.g., rush subcutaneous immunotherapy, penicillin, insulin, or antitoxin desensitization) and does not accurately describe oral food immunotherapy.
- Many payers (including Medicare contractors) have explicitly denied or recouped payments when 95180 has been used for food OIT, and some consider it inappropriate coding.
Current ACAAI/AAAAI recommended coding (unchanged since 2021)
Initial escalation day (Day 1) – if no recent oral food challenge has been performed:
- 95076 – Ingestion challenge, initial 120 minutes
- +95079 – Each additional 60 minutes (list separately)
If ingestion challenge codes are not appropriate (e.g., recent challenge already performed), use office/outpatient E/M codes (99202–99205 or 99212–99215) selected by medical decision-making or total physician time.
Up-dosing and maintenance visits:
- Office/outpatient E/M codes (typically 99213–99215)
- Add prolonged service codes when applicable:
- Non-Medicare: 99417 (each 15 min beyond the time of 99215 or 99205)
- Medicare: G2212 (each 15 min beyond the time of 99215 or 99205)
The College acknowledges that some people performing OIT do not agree with this recommendation, and that individual insurance companies may provide coverage using code 95180. Always verify individual payer policies in writing before initiating OIT services, as coverage and accepted codes vary widely. Many commercial payers still classify food OIT as investigational or non-covered, regardless of the code submitted.
Why do we not pursue a dedicated OIT CPT code at this time?
Creating a specific CPT code would make it significantly easier for payers to exclude the service entirely from coverage. The absence of a dedicated code actually provides more flexibility for practices to bill using existing allergy/immunology codes or, in some cases, to offer OIT on a cash-pay/out-of-network basis. If we were successful in getting a code, insurance companies could also restrict use to FDA approved products.
We continue to focus advocacy resources on securing fair payment for traditional allergen immunotherapy (95165 et al.) and on broader food-allergy policy issues.
Thank you for your continued commitment to providing high-quality care to food-allergic patients. Please direct any additional coding questions to the ACAAI Advocacy Council.
For additional coding resources, please review the College’s Coding Toolkit.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
