Insurance Coverage for Allergy Shots

We have prepared this letter to assist you in determining your insurance coverage associated with allergy shots.

If you have decided to start allergy injections for you or your child we ask that you contact your insurance company directly to clarify your coverage. There is usually a phone number on the back of your insurance card.

There are two charges associated with allergy shots. There is a charge for the allergy serum (extract) and a charge for the nurse to administer the shot(s). Charges will also depend on if you are getting one or two shots each time.

SERUM -- Billing  Code 95165
First there is a charge for the serum that is injected. Each patient has their own serum (extract) specifically made for them and stored in the office with their name on it. It is only used for that patient and no one else. The serum is formulated by the physicians and is based on what you are allergic to. For some patients we are able to mix everything into one bottle and they get one injection each time. Other patients have more complicated mixtures. Some allergens do not mix well so they have to be separated in to two different bottles. These patients require two injections at a time (usually one in each arm).

The serum is charged upfront in groups of 12. When you first start the program, you will be charged for 12 units of serum if you are getting one injection each time, and 24 units if you require two separate shots each time. After you have received the 12 sets of injections, you will be billed again for your next set of 12 injections. Again this will be 12 units for one injection and 24 units if you require two separate injections. This cycle continues to repeat as you receive your injections.

SERUM INJECTION -- Billing  Code 95115/95117
There is a charge for the nurse to administer the shot(s). This is charged each time you come in for your shots. If you are getting one injection the code is 95115 and if you are getting two injections each time it is 95117.

It is important that you ask specifically about coverage for the serum (95165) and for the administration of the allergy shot (95115 or 95117). You may also want to know if there are any restrictions on the number of injections you can get per year. You may also want to ask about your deductible which must be satisfied by you every year before your coverage starts.

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