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See a sample rate comparisonCPT 95065 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Direct Nasal Mucous Membrane Test
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Allergy and Clinical Immunology Procedures |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | XS - Separate Structure 50 - Bilateral Procedure |
| Complexity Level | Low |
| Medicare Fee Schedule | $28.06 national non-facility rate (2026) · View Medicare rates for 95065 |
| Medicaid Fee Schedule | $22.50 median of the 8 states in the free preview · View Medicaid rates for 95065 |
National average reimbursement for CPT 95065 by major payers:
$36.59
$29.16
$29.36
$36.61
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CPT 95065
5 of 25 sample ratesHigher to lower in this preview
Sunila Oconnor
Pediatric Faculty Foundation In
$60.49Published rateSteven Sharp
Loyola University Medical Center
$50.00Published rateCorey Goldstein
$47.88Published rateEdwin Cook
The Board Of Trustees Of The University Of Illinois
$38.58Published rateAbbas Naqvi
Town Center Orthopaedic Associates, P.C.
$23.32Published rate
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See a sample payer proposalCPT 95065 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95065 code is part of the Medicine Services and Procedures services used for Allergy and Clinical Immunology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95065 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95060-CPT | Low | Ophthalmic Mucous Membrane Tests |
| 95065-CPT | Low | Direct Nasal Mucous Membrane Test |
| 95070-CPT | Low | Inhalation Bronchial Challenge, Inhalation Bronchial Challenge Testing (Not Including Necessary Pulmonary Function Tests) With Histamine Methacholine Or Similar Compounds |
| 95076-CPT | Low | Ingest Challenge Ini 120 Min, Ingestion Challenge Test Sequential And Incremental Ingestion Of Test Items Eg Food Drug Or Other Substance Initial 120 Minutes Of Testing |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95065. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95065 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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