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36.4.2.1 Allergy Injections, Vials and Extracts
Allergen immunotherapy consists of 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.
Preparation of the allergy vial or extracts is a benefit of the Texas Medicaid Program and should be submitted using the following procedure codes:
The preparation of the allergy vial or extract must be submitted with an appropriate diagnosis code as follows:
The quantity billed should represent the total number of cc in the vial. If the number of cc is not stated on the claim, a quantity of one is allowed.
When an injection is given from a vial, providers should use an administration-only procedure code (1-95115 or 1-95117).
An office visit, clinic visit, or observation room is not considered for reimbursement in addition to the fee for preparation of the allergy vial or administration, unless the visit was for a different (non-allergy related) diagnosis or re-evaluation of the patient's condition.
The following E/M procedure codes submitted with allergy testing or allergy immunotherapy are appropriate only if a significant, separately identifiable service is administered:
Single dose vials (procedure code 1-95144) are not a benefit of the Medicaid program.
Sublingual antigens are not a benefit of the Texas Medicaid Program.
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