Common Allergy CPT Codes and MUEs

October 30th, 2018 - Find-A-Code™
Categories:   Allergy|Immunology   CPT® Coding   Medicare  
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Below is a list of common CPT codes for Allergy and Immunology. Each code is listed with the following information:

  • Medicare Unlikely Edits (MUEs) for both a Non-Facility (NF) and Facility (F) setting.
  • Professional/Technical Component (PC/TC) Indicator.
  • Key Indicator or Procedure Code Status Indicator, which is a Medicare assigned "Indicator" to each code in the Medicare Fee Schedule. It indicates whether a code is separately payable, if the service is covered, etc.

Beneath the table is a list of Indicator codes/letters and their descriptions.

CPT Code

Code Description

MUEs NF

MUEs F

PC/TC Indicator

Key Indicator

95004

Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests

80

80

0

A

95012

Nitric oxide expired gas determination

2

2

5

A

95017

Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests

27

27

0

A

95018

Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests

19

19

0

A

95024

Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests

40

40

0

A

95027

Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests

90

90

0

A

95028

Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests

30

30

3

A

95044

Patch or application test(s) (specify number of tests)

80

80

5

A

95052

Photo patch test(s) (specify number of tests)

20

20

5

A

95056

Photo tests

1

1

5

A

95060

Ophthalmic mucous membrane tests

1

1

3

A

95065

Direct nasal mucous membrane test

1

1

3

A

95070

Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine, or similar compounds

1

1

3

A

95071

Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify

1

1

3

A

95076

Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing

1

1

0

A

95079

Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); each additional 60 minutes of testing (List separately in addition to code for primary procedure)

2

2

0

A

95115

Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection

1

1

5

A

95117

Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections

1

1

5

A

95120

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single injection

0

0

9

I

95125

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 or more injections

0

0

9

I

95130

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom

0

0

9

I

95131

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 2 stinging insect venoms

0

0

9

I

95132

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 3 stinging insect venoms

0

0

9

I

95133

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 4 stinging insect venoms

0

0

9

I

95134

Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; 5 stinging insect venoms

0

0

9

I

95144

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single dose vial(s) (specify number of vials)

30

30

0

A

95145

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); single stinging insect venom

10

10

0

A

95146

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 2 single stinging insect venoms

10

10

0

A

95147

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 3 single stinging insect venoms

10

10

0

A

95148

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 4 single stinging insect venoms

10

10

0

A

95149

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 5 single stinging insect venoms

10

10

0

A

95165

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)

30

30

0

A

95170

Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; whole body extract of biting insect or other arthropod (specify number of doses)

10

10

0

A

95180

Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine serum)

6

8

0

A

95199

Unlisted allergy/clinical immunologic service or procedure

1

1

0

C

Key Indicators

Indicator

Description

A

Active Code: These codes are paid separately under the physician fee schedule, if covered.

C

Carriers Price the Code: Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report.

I

Not valid for Medicare Purposes: Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.)

PC/TC Indicators

Indicator

Description

0

Physician Service Codes -- Identifies codes that describe physician services.

3

Technical Component Only Codes -- This indicator identifies stand- alone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic test only.

5

Incident To Codes -- This indicator identifies codes that describe services covered incident to a physician's service when they are provided by auxiliary personnel employed by the physician and working under his or her direct personal supervision.

9

Not Applicable -- Concept of a professional/technical component does not apply.

Please Note: This list does not include all codes and is informational only (Includes information from CMS and other Payers) - Please consult your specific payer(s) rules and coverage guidance.

MUEs according to CMS effective 10/01/2018. Click Here for more information. 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


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