CPT 95180: Allergenic Extract Provision for Immunotherapy
CPT code 95180 denotes the preparation and provision of an allergenic extract used in allergen immunotherapy. This code is central to practices that diagnose and treat IgE-mediated allergic conditions and supports delivery of tailored allergen extracts for desensitization or maintenance therapy. Nationally, accurate coding for allergenic extract provision affects clinical documentation, billing consistency, and reimbursement workflows across outpatient allergy services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of how CPT code 95180 is classified, the clinical context for its use in allergy and immunology services, and comparisons to related immunotherapy codes. The publication outlines typical sites of service and the role of this code alongside professional allergen immunotherapy services.
This summary prepares clinicians, billing professionals, and policy analysts to understand where 95180 fits within allergen immunotherapy service lines, how it relates to associated professional service codes, and what benchmarks and policy considerations commonly inform payer coverage and claims processing. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 95180 describes the preparation and provision of an allergenic extract used in allergen immunotherapy. The code falls under the Medicine section, subsection Allergy and Clinical Immunology/Allergen Immunotherapy, and represents a biologic protein extract purified from a substance to which a patient may be allergic.
Service Type: Provision of allergenic extract for immunotherapy
Typical Site of Service: Allergy clinic or outpatient medical office where allergen immunotherapy is managed
National Reimbursement Benchmarks
Medicare’s mean rate of $142.4 sits notably below BUCA’s average commercial mean of $243.6, indicating a roughly $101.2 gap between public and this commercial benchmark for CPT 95180. That gap highlights how commercial averages can substantially exceed the Medicare baseline, with BUCA roughly 71% higher than Medicare on mean reimbursement.
Dispersion (P75−P25) varies across payers: Blue Cross Blue Shield has a wide spread of $116.5 (P75 $361.9 − P25 $245.4), indicating more variability in contracted rates, while Aetna’s spread is $90.9 (P75 $134.9 − P25 $43.6). UnitedHealth Group shows a spread of $115.3 (P75 $242.0 − P25 $127.7), and Cigna’s spread is $95.3 (P75 $221.8 − P25 $126.5). BUCA’s interquartile spread is $109.5 (P75 $292.3 − P25 $182.8). By these IQRs, Blue Cross Blue Shield is the widest and Aetna is the tightest among the listed commercial payers.