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See a sample rate comparisonCPT 95131 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.
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 (Revised 01/01/13)
| 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 | 59 - Distinct Procedural Service PN - Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95131 |
| Medicaid Fee Schedule | $20.965 median of the 8 states in the free preview · View Medicaid rates for 95131 |
National average reimbursement for CPT 95131 by major payers:
$40.24
$33.21
$26.97
$237.94
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CPT 95131
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$57.08Published rateRhonda Lampen
$46.58Published rateBishoy Goubran
$42.09Published rateJoseph Pepitone
Northshore University Healthsystem Faculty Practice Associates
$37.31Published rateNitin Patel
$22.05Published rate
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See a sample payer proposalCPT 95131 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95131 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 95131 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 |
|---|---|---|
| 95130-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 Stinging Insect Venom (Revised 01/01/13) |
| 95131-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 Stinging Insect Venoms (Revised 01/01/13) |
| 95132-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; 3 Stinging Insect Venoms (Revised 01/01/13) |
| 95133-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; 4 Stinging Insect Venoms (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 95131. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95131 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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