CPT 95170 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 76 - Repeat procedure by same physician • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 95170 by major payers:
$10.72
$11.18
$11.03
$14.49
| 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 95170 | ||||||
United | 95170 | $19.07 | 1912385295 - ALYSSA STRAM | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 95170 | $21.06 | 1962664789 - JAMIE EVANS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | NC | Psychiatry Physician (2084P0800X) |
United | 95170 | $27.62 | 1891921367 - KAVITA THAKKAR | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95170 | $11.39 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 95170 | $20.54 | 1801849559 - CHARLES MARCUCCILLI | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95170 | $8.77 | 1710275110 - PRAVESH DEOTALE | 430654872 - ST LOUIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95170 | $24.65 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95170 | $30.20 | 1760412621 - RHONDA LAMPEN | 911352172 - MULTICARE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 95170 | $18.28 | 1700895257 - LARA SEGALITE | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95170 | $22.29 | 1780078337 - MATTHEW FILIPPO | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 95170 | $27.48 | 1790936540 - SRISHTI NANGIA | 131623978 | NY | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95170 | $15.28 | 1285719260 - TANMOY CHANDRA | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 95170 | $21.87 | 1851654834 - MEGAN BARRY | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95170 | $20.53 | 1235186297 - MARY DOBBINS | 376005961 - (IL) BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95170 | $18.45 | 1639691090 - KELLY RHODES | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
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 95170 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95170 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 95170 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 |
|---|---|---|
| 95144-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy; Single Dose Vial(S) (Specify Number Of Vials) |
| 95145-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy (Specify Number Of Doses); Single Stinging Insect Venom |
| 95146-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy (Specify Number Of Doses); Two Single Stinging Insect Venoms |
| 95170-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy; Whole Body Extract Of Biting Insect Or Other Arthropod (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 95170. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95170 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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