CPT 95165 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 • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 76 - Repeat procedure by same physician • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95165 |
National average reimbursement for CPT 95165 by major payers:
$15.95
$16.52
$18.07
$20.34
| 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 95165 | ||||||
United | 95165 | $15.93 | 1225086820 - TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK, TTUHSC-ALLERGY | 752668018 | TX | Allergy & Immunology Physician (207K00000X) |
United | 95165 | $14.85 | 1336231802 - PATRICK MACHADO | 300791563 | TX | Physical Therapist (225100000X) |
United | 95165 | $15.21 | 1851448815 - ERIC REED | 823953636 | TX | Otolaryngology Physician (207Y00000X) |
United | 95165 | $13.31 | 1184664492 - PATRICK GOMEZ | 853142181 - (TX) CGN EPENT | TX | Otolaryngology Physician (207Y00000X) |
United | 95165 | $16.28 | 1285914366 - ALLISON HARRIS | 800240816 - (TX) THE ENT ALLERGY CENTERS OF TEXAS PLLC | TX | Audiologist (231H00000X) |
United | 95165 | $12.93 | 1841354644 - LAURIE BORNSTEIN | 461406481 | TX | Audiologist-Hearing Aid Fitter (237600000X) |
United | 95165 | $11.84 | 1235618869 - EMILY WASCOMB | 813180280 - (TX) CLEARCUT ORTHO LLC | TX | Physical Therapist (225100000X) |
United | 95165 | $36.59 | 1962846782 - STEPHEN CHORNEY | 756002868 | TX | Pediatric Otolaryngology Physician (207YP0228X) |
United | 95165 | $22.78 | 1194721696 - DALE MOHAR | 455107943 | TX | Allergy & Immunology Physician (207K00000X) |
United | 95165 | $30.56 | 1841719671 - SAMANTHA POWERS | 232743545 | TX | Audiologist (231H00000X) |
United | 95165 | $12.57 | 1285625699 - BARRY PAULL | 742119746 - (TX) ALLERGY ASSOCIATES OF BRAZOS VALLEY | TX | Allergy & Immunology Physician (207K00000X) |
United | 95165 | $36.59 | 1265877054 - JEFFREY CHAMBLISS | 756002868 | TX | Pediatric Allergy/Immunology Physician (2080P0201X) |
United | 95165 | $14.50 | 1134474281 - WILLIAM MURRAY | 752614816 - (TX) AMARILLO BONE JOINT CLINIC PLLC | TX | Physical Therapist (225100000X) |
United | 95165 | $12.57 | 1801358858 - PALMILA LIU | 752306021 - (TX) TEXAS EAR NOSE THROAT SPECIALISTS LLP | TX | Otolaryngology Physician (207Y00000X) |
United | 95165 | $9.61 | 1518434026 - MAURICIO RUIZ | 10788187 - (TX) LAREDO SPORT MEDICINE CLINIC, PA | TX | Physical Therapist (225100000X) |
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 95165 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95165 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 95165 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) |
| 95165-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy; Single Or Multiple Antigens (Specify Number Of Doses) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95165. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95165 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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