Summary & Overview
CPT 95115: Allergen Immunotherapy, Single Injection
CPT code 95115 is a widely used billing code for professional services related to allergen immunotherapy, specifically for the administration of a single injection. This code is significant in allergy and immunology practices across the United States, as it enables providers to bill for the clinical service of administering immunotherapy to patients with various allergic conditions. The code does not include the cost or provision of allergenic extracts, focusing solely on the injection service itself.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare recognize and reimburse for CPT 95115, making it a key code for practices specializing in allergy and immunology. The publication provides an overview of payer coverage, clinical context, and policy updates relevant to this procedure. Readers will gain insights into typical sites of service, common clinical indications, and related codes, as well as current benchmarks and billing considerations for allergen immunotherapy. The summary also highlights the importance of understanding payer-specific requirements and modifiers associated with this code, ensuring accurate billing and compliance in clinical practice.
CPT Code Overview
CPT 95115 represents professional services for allergen immunotherapy, specifically for a single injection. This procedure is part of the Allergy and Clinical Immunology Procedures service type and is typically performed in a clinical setting such as a physician's office. The code covers the administration of immunotherapy to help manage allergic conditions, but does not include the provision of allergenic extracts. This service is commonly used for patients requiring ongoing allergy treatment under the supervision of a specialist.
Clinical & Coding Specifications
Clinical Context
A patient with a history of allergic rhinitis, asthma, or allergic conjunctivitis presents to the office of an allergy and immunology specialist. After evaluation and confirmation of the diagnosis, the provider determines that allergen immunotherapy is indicated. The patient receives a single injection of allergenic extract as part of their ongoing immunotherapy regimen. The procedure is performed in a clinical setting, such as a physician's office, under the supervision of a qualified allergy and immunology provider. The visit may include assessment of symptoms, review of previous reactions, and monitoring for adverse effects post-injection.
Coding Specifications
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Modifiers:
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Modifier
25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the allergen immunotherapy injection. This modifier distinguishes the E/M service from the procedure. -
Modifier
59: Used to indicate a distinct procedural service, such as when the allergen immunotherapy injection is performed separately from other procedures or services on the same day.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207K00000XAllergy & Immunology Physician 207RA0201XAllergy Physician 207RI0008XClinical & Laboratory Immunology Physician
These taxonomies represent providers specializing in allergy, immunology, and clinical laboratory immunology.
Related Diagnoses
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H10.411– Chronic giant papillary conjunctivitis, right eye- Relevant for patients with chronic allergic conjunctivitis affecting the right eye, who may benefit from allergen immunotherapy.
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H10.412– Chronic giant papillary conjunctivitis, left eye- Indicates chronic allergic conjunctivitis in the left eye, supporting the need for immunotherapy.
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H10.413– Chronic giant papillary conjunctivitis, bilateral- Bilateral involvement of chronic allergic conjunctivitis, often managed with allergen immunotherapy.
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H10.45– Other chronic allergic conjunctivitis- Covers other forms of chronic allergic conjunctivitis, which may be treated with immunotherapy.
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J30.0– Vasomotor rhinitis- Non-allergic rhinitis that may be considered for immunotherapy if symptoms are severe.
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J30.1– Allergic rhinitis due to pollen- Common indication for allergen immunotherapy, especially during pollen seasons.
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J30.2– Other seasonal allergic rhinitis- Includes allergic rhinitis triggered by seasonal allergens, suitable for immunotherapy.
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J30.81– Allergic rhinitis due to animal (cat) (dog) hair and dander- Patients allergic to animal dander may receive immunotherapy to reduce symptoms.
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J30.89– Other allergic rhinitis- Encompasses other types of allergic rhinitis, often managed with immunotherapy.
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J31.0– Chronic rhinitis- Chronic rhinitis may be treated with immunotherapy if allergic etiology is confirmed.
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J45.20– Mild intermittent asthma, uncomplicated- Asthma patients with mild intermittent symptoms may benefit from allergen immunotherapy.
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J45.30– Mild persistent asthma, uncomplicated- Immunotherapy may be indicated for mild persistent asthma with allergic triggers.
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J45.40– Moderate persistent asthma, uncomplicated- Moderate persistent asthma with allergic components can be managed with immunotherapy.
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J45.50– Severe persistent asthma, uncomplicated- Severe asthma patients may receive immunotherapy as part of their treatment plan.
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T63.421A– Toxic effect of venom of ants, accidental (unintentional), initial encounter- Relevant for patients undergoing immunotherapy for ant venom allergy, initial visit.
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T63.421D– Toxic effect of venom of ants, accidental (unintentional), subsequent encounter- Used for follow-up visits in ant venom immunotherapy.
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T63.421S– Toxic effect of venom of ants, accidental (unintentional), sequela- Indicates sequelae from ant venom exposure, managed with immunotherapy.
Related CPT Codes
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95117– Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections at a single visit- Used when multiple injections are administered during the same visit. It is an alternative to
95115when more than one injection is given.
- Used when multiple injections are administered during the same visit. It is an alternative to
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95144– Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (single-dose vials) when performed by the allergist- Used for the preparation and provision of allergenic extracts in single-dose vials. May be used in conjunction with injection codes when the allergist prepares the extracts.
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95165– Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens- Used for the preparation and provision of allergenic extracts in multi-dose vials. Often billed alongside injection codes when the provider supervises the preparation of antigens.
These codes are commonly used together in the clinical workflow for allergen immunotherapy, depending on the number of injections and the preparation of extracts.
National Reimbursement Benchmarks
Medicare's national mean rate for CPT code 95115 is $10.73, which is notably lower than the BUCA (average commercial) mean rate of $13.69. Among the major commercial payers, Cigna has the highest mean rate at $16.28, while Aetna is the lowest at $11.67.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare shows the tightest range at $1.00, indicating minimal variation in rates. In contrast, Cigna exhibits the widest dispersion at $8.00, followed by UnitedHealth Group at $8.50, reflecting greater variability in commercial reimbursement. Blue Cross Blue Shield and BUCA also show moderate ranges of $5.00 and $6.67, respectively.
The table and chart below present the full breakdown of national benchmarks for CPT code 95115 across all major payers.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 95115, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($14.88), while Aetna and UnitedHealth Group display minimal spread ($0.00 and $0.50, respectively). This indicates that some payers have highly consistent rates, whereas others, like Blue Cross Blue Shield and BUCA, offer more variable reimbursement depending on provider contracts.
Compared to national averages, all commercial payers in Alaska reimburse at substantially higher rates for CPT code 95115. The table and chart below present the full breakdown of mean rates and percentile values by payer, highlighting Alaska's premium reimbursement environment for this procedure.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 95115 in Alaska, with a mean rate of $34.24.
- Medicare is the lowest paying payer, with a mean rate of $10.28.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Blue Cross Blue Shield and BUCA showing the largest deviations.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.