CPT 95117 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 95117: Allergen Immunotherapy, Two or More Injections

CPT code 95117 is a key billing code for allergen immunotherapy, specifically covering professional services for administering two or more injections at a single visit. This procedure is widely used in allergy and immunology practices to treat patients with various allergic conditions, including rhinitis, conjunctivitis, and asthma. The code is relevant for providers seeking reimbursement for multi-injection immunotherapy sessions, which are a cornerstone of allergy management.

Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare recognize and reimburse for services billed under CPT code 95117. The publication provides an overview of payer coverage, clinical context, and policy updates related to this code. Readers will gain insights into typical sites of service, common clinical indications, and associated billing practices. The summary also highlights related codes and modifiers that may impact reimbursement and compliance.

This article is intended for healthcare professionals, billing specialists, and policy analysts who need a comprehensive understanding of CPT code 95117 in the context of allergen immunotherapy. It covers benchmarks, payer policies, and clinical scenarios to support accurate billing and documentation.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 95117allergen immunotherapyallergy and immunologyoffice visitmedical billingmulti-injectionclinical codingpolicy updatereimbursementprocedure overview

CPT Code Overview

CPT code 95117 represents professional services for allergen immunotherapy involving two or more injections administered during a single office visit. This code is used in the field of Allergy and Immunology and is typically performed in an office setting (Place of Service 11). The procedure is designed to help patients manage allergic conditions by providing immunotherapy through multiple injections, which can improve tolerance to allergens and reduce symptoms over time.

Clinical & Coding Specifications

Clinical Context

A patient with a history of allergic rhinitis, asthma, or chronic conjunctivitis presents to the allergy/immunology office for ongoing allergen immunotherapy. During the visit, the patient receives two or more allergen injections as part of their scheduled treatment plan. The injections are administered by clinical staff under the supervision of an allergy/immunology specialist. The visit does not include the provision or preparation of allergenic extracts, only the administration of the injections. The patient may also have a separate evaluation and management service if clinically indicated, which would be documented and coded separately.

Coding Specifications

Modifier 25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same provider on the same day as the allergen immunotherapy injections. This modifier allows for billing both the E/M service and the injection procedure.

Modifier Code	Description
`25`	Significant, separately identifiable Evaluation and Management service on the same day

Provider Taxonomies:

National Reimbursement Benchmarks

Medicare's national mean rate for CPT code 95117 is $12.83, which is notably lower than the BUCA (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) commercial average of $16.43. Commercial payers consistently reimburse at higher rates compared to Medicare, with Cigna and UnitedHealth Group offering the highest mean rates among the group.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the tightest range at $1.00, indicating minimal variation in rates. In contrast, Cigna and UnitedHealth Group show the widest dispersions, with ranges of $9.67 and $10.50 respectively, reflecting greater variability in commercial reimbursement. Aetna and Blue Cross Blue Shield have moderate ranges of $8.00 and $6.00.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide spread in reimbursement rates for CPT code 95117, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($19.02), while Aetna and UnitedHealth Group display minimal spread ($0.00 and $0.50, respectively). This indicates that some payers have highly consistent rates, while others vary substantially across providers. Commercial payers in Alaska, such as Blue Cross Blue Shield and BUCA, offer mean rates that are notably higher than their national averages, with Blue Cross Blue Shield's mean rate in Alaska more than double its national mean.

The table and chart below present the full breakdown of mean, 25th, 50th, and 75th percentile rates for each major payer in Alaska. This comparison highlights the significant variation in reimbursement across payers and the elevated rates relative to national benchmarks.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 95117 in Alaska, with a mean rate of $38.85.
Medicare is the lowest paying payer in Alaska, with a mean rate of $12.28.
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.

CPT 95115: Allergen Immunotherapy, Single Injection

CPT-95170-INSECT-ARTHROPOD-ALLERGEN-EXTRACT-PREPARATION

CPT 95170: Insect/Arthropod Whole Body Allergen Extract Preparation

CPT-95199-ALLERGY-IMMUNOLOGY-UNLISTED-PROCEDURE

CPT 95199: Unlisted Allergy and Immunology Procedure

CPT-95120-ALLERGEN-IMMUNOTHERAPY-SINGLE-INJECTION

CPT 95120: Allergen Immunotherapy Injection, Single Dose

CPT-95133-STINGING-INSECT-VENOM-IMMUNOTHERAPY-OFFICE-ADMINISTRATION

CPT 95133: Stinging Insect Venom Immunotherapy, Office Administration

CPT-95134-VENOM-IMMUNOTHERAPY-FIVE-INSECT-VENOMS-OFFICE-ADMINISTRATION

CPT 95134: Office Administration of Venom Immunotherapy for Insect Stings

CPT-95147-STINGING-INSECT-VENOM-EXTRACT-PREPARATION

CPT 95147: Preparation of Three Single Stinging Insect Venom Extracts

95180-RAPID-DESENSITIZATION-PROCEDURE-EACH-HOUR-EG-INSULIN

CPT 95180: Rapid Desensitization Procedure for Medication Allergies

CPT-95144-ALLERGEN-IMMUNOTHERAPY-ANTIGEN-PREPARATION-SINGLE-DOSE-VIALS

CPT 95144: Allergen Immunotherapy Antigen Preparation, Single-Dose Vials

CPT-95149-STINGING-INSECT-VENOM-EXTRACT-PREPARATION

CPT 95149: Preparation of Five-Sting Insect Venom Extracts

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Summary & Overview

CPT 95117: Allergen Immunotherapy, Two or More Injections

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes