The Advocacy Council often gets questions from College members wondering what the correct codes for SLIT are. Luckily, we’ve got the answers!
What are the correct codes to use for Sublingual Immunotherapy (SLIT)?
While there are now three FDA-approved tablets (grass, ragweed and dust mite), sublingual immunotherapy (SLIT) using liquid allergen extracts is still considered experimental and is not FDA approved. There is not a CPT specific code for SLIT. It is NOT appropriate to use CPT 95165 since this code only applies to subcutaneous immunotherapy (SCIT) for “the parenteral administration of allergenic extracts as antigens at periodic intervals, usually on an increasing dosage scale to a dosage which is maintained as maintenance therapy.” You could use the miscellaneous code 95199 which describes “unlisted allergy/clinical immunologic service or procedure;” however, this does not guarantee reimbursement. Most payers will not pay for this code, at least not without a description of the service provided. We suggest checking with the patient’s insurance company to see if they will reimburse for the service.
Is there a specific code that can be used for starting patients on the FDA approved sublingual immunotherapy tablets in the office?
There is no identifiable separate code. An E&M code may be appropriate if the tablet administration includes time spent with the patient educating them on possible reactions, anaphylaxis, use of an auto-injector, and keeping them under observation in the office for 30 minutes. If more than half of the time spent was for counseling and coordination of care, an E&M code based on time may also be appropriate.
If you’re looking for more help with coding (and who isn’t?), our newly updated coding toolkit is packed with tons of great resources to help you out with CPT and ICD-10 coding. We have answers to dozens of FAQs on everything from 95165 to Xolair.