Common Allergy CPT Codes and MUEs

October 30th, 2018 - Find-A-Code™

Categories: Allergy|Immunology CPT^® Coding Medicare

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.

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