CPT 95165: Antigen Preparation for Allergen Immunotherapy
Medicare pays $18 and commercial payers pay $72 on average nationally for this procedure.
CPT code 95165 describes the preparation and mixing of allergen antigens for allergen immunotherapy, a clinical laboratory/procedure service where the provider compounds one or more antigen extracts used in allergy shots; typical site of service is an allergy clinic or physician office performing immunotherapy preparation and related injection services.
For related coverage guidance, see recent payer policy updates: Diagnosis of Idiopathic Environmental Intolerance, Allergen Testing, Allergen Testing.
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National Reimbursement Benchmarks
Medicare mean reimbursement for CPT 95165 is $18.10, while BUCA (average commercial) reports a substantially higher mean of $72.00, indicating commercial average rates are roughly four times the Medicare average for this code. Other commercial payers’ means fall between those points: Aetna $231.20 (note Aetna’s mean is elevated by a large max), Blue Cross Blue Shield $61.10, Cigna $12.50, and UnitedHealth Group $15.80.
Rate dispersion varies notably across payers. Compute P75–P25 ranges where available: Aetna range = 337.5 - 7.7 = 329.8 (widest), Blue Cross Blue Shield range = 76.0 - 50.4 = 25.6, BUCA range = 97.4 - 31.6 = 65.8, Cigna range = 18.9 - 4.5 = 14.4 (tightest among those with quartiles), UnitedHealth Group range = 21.7 - 7.6 = 14.1 (also very tight). Medicare quartiles are clustered (P25 17, P75 19) indicating a tight distribution around the mean. These ranges highlight Aetna’s extensive spread and Cigna and UnitedHealth Group’s relatively narrow interquartile ranges.
The table and chart below present the full breakdown of percentiles, means, medians, and extreme values for each payer listed: Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group, BUCA, and Medicare.