CPT Code 95115: Allergen Immunotherapy Injection (Single)

What is CPT code 95115?

CPT code 95115 is used to report the administration of a single allergen immunotherapy injection, excluding the preparation of the extract itself. This code is applicable when a healthcare provider administers an allergenic extract that has already been prepared—either by the same physician, another provider, or a pharmacy. It is often associated with subcutaneous immunotherapy (SCIT), which delivers allergens beneath the skin to desensitize the immune response.

This code is part of allergy testing and immunotherapy procedures and is appropriate when single-dose vials or multiple-dose vials are used for venom treatment, especially for conditions like anaphylactic reaction due to insect stings, including the toxic effect of venom from ants, wasps, hornets, or bees.

Venom immunotherapy and diagnosis scenarios

Venom-related reactions are often linked to immunotherapy. Accurate coding involves documenting whether the exposure was accidental, unintentional initial encounter, intentional self-harm initial, self-harm subsequent encounter, or intentional self-harm sequela.

You may encounter codes associated with:

• Venom of ants accidental, venom of bees accidental, or venom of hornets accidental
• Venom of wasps intentional, venom of hornets intentional, or venom of bees intentional
• Venom of hornets undetermined, venom of wasps undetermined, venom of bees undetermined
• Toxic effect of venom of ants, intentional self-harm, and can also apply for effects of other venoms such as hornets, bees intentional and wasps, intentional self harm.
• Venom of ants assault, venom of bees assault, and venom of wasps assault
• Situations involving intentional self-harm subsequent or self-harm initial encounter

Ensure you use the correct ICD-10 codes with your CPT procedure codes to reflect the toxicity or reaction due to medicaments and biological substances.

Immunotherapy extract and dose considerations

• CPT Code 95115 only covers the injection, not the extract preparation.
• Use 95165 to report the number of doses prepared and more or fewer doses administered.
• Some extracts may be considered single-dose codes, and billing may vary.
• Multi dose vial usage must be documented accurately for payer review.
• Catch up billing is not permitted; only bill for services rendered at the time of encounter.

CPT code 95115 documentation requirements

Accurate documentation is critical when you bill CPT Code 95115. Providers should include the following:

• Allergen extract name, number of doses, and codes representing antigens
• Injection code, site, and time of administration
• Date and time of the visit
• Post-injection monitoring, usually for 20–30 minutes
• Any adverse events, such as a reaction due to vaccination or an allergic response
• Signature of the provider or supervised personnel
• Note if the dose was removed from the vial (important for single dose codes)

CPT code 95115 billing guidelines

• Use CPT code 95115 once per visit for a single injection.
• If multiple injections are given, use CPT code 95117.
• Do not report 95115 with CPT code 95165 unless your office prepared the extract.
• Proper evaluation and management services should be reported separately if it’s a separately identifiable visit service.
• Ensure services meet Medicare Physician Fee Schedule criteria and check Medicare National Coverage Determinations (NCD Manual) for payer-specific rules.

Providers may bill Medicare if the allergen immunotherapy service provided is medically necessary and documented, including under scenarios involving venom of ants, undetermined, venom of bees, intentional, or venom of hornets, assault.

Related CPT codes

• 95117 – For two or more immunotherapy injections
• 95165 – For the preparation of allergenic extract (prepared in separate vials)
• Other appropriate CPT procedure codes may apply depending on the case complexity