CPT 95115 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Allergy and Clinical Immunology Procedures |
| Common Place of Service | • 11 - Office • 72 - Rural Health Clinic |
| Common Modifiers | • None • 59 - Distinct Procedural Service • SA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95115 |
National average reimbursement for CPT 95115 by major payers:
$13.94
$12.68
$13.12
$15.06
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 95115 | ||||||
United | 95115 | $9.18 | 1922610682 - KAUFMAN ALLERGY ASTHMA AND IMMUNOLOGY, PLLC | 850752386 - (VA) KAUFMAN ALLERGY ASTHMA AND IMMUN | VA | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $8.39 | 1093863334 - MARC GOLDSTEIN | 223040614 - (PA) ALLERGIC DISEASE ASSOCIATES PC | PA | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $14.63 | 1669492799 - RICHARD LOONEY | 160743209 - UNIVERSITY OF ROCHESTER | NY | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $50.36 | 1447263652 - HOWARD SCHANKER | 954377219 | CA | Clinical & Laboratory Immunology (Allergy & Immunology) Physician (207KI0005X) |
United | 95115 | $25.64 | 1790094423 - MELANIE MAKHIJA | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $6.57 | 1740511740 - NEHA BHAMBRI | 822812132 - (NJ) NJ ALLERGY ASTHMA CARE LLC | NY | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $17.46 | 1053348060 - SARAH WISE | 582030692 - EMORY UNIVERSITY | GA | Otolaryngic Allergy Physician (207YX0602X) |
United | 95115 | $12.61 | 1205493376 - KELLY SHIBUYA | 421752196 - (HI) ABIGAIL S HARADA M D L L C | CO | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $16.92 | 1023035789 - DEBORAH WEICHENBERG | 223341716 | NY | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $28.79 | 1033853353 - NORTHEAST ALLERGY | 881848899 - (MA) NORTHEAST ALLERGY | MA | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $8.82 | 1336427814 - SHARON YEE | 133579712 - ALLERGY & ASTHMA CONSULTANTS OF ROCKLAND & BERGEN, P.C. | NJ | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $6.57 | 1326098120 - DAVID PROVENCHER | 562404133 - (FL) PLANT CITY ALLERGY, P.A. | FL | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $30.84 | 1588707137 - JENNIFER KOZIOL WOZNIAK | 410797853 - GROUP HEALTH PLAN INC | MN | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $11.92 | 1285833566 - SAHAR RIDA | 300207639 - (IL) SAHAR K RIDA MD SC | IL | Allergy & Immunology Physician (207K00000X) |
United | 95115 | $8.60 | 1205826559 - ALLERGY PARTNERS, PLLC, ALLERGY PARTNERS OF WESTERN NORTH CAROLINA | 561249571 - ALLERGY PARTNERS, PLLC | NC | Allergy & Immunology Physician (207K00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 95115 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95115 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 95115 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 |
|---|---|---|
| 95115-CPT | Low | Prof.Serv-Allergen Therapy;1 Injec |
| 95117-CPT | Low | Prof.Serv-Allergn Therapy;Multi Inj |
| 95120-CPT | Low | 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 (Revised 01/01/13) |
| 95125-CPT | Low | 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 (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95115. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95115 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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