CPT 95180: Allergenic Extract Preparation
Medicare pays $142 and commercial payers pay $244 on average nationally for this procedure.
CPT code 95180 describes professional services for preparation of an allergenic extract used in allergen immunotherapy; the service involves deriving and preparing protein extracts for patient-specific allergy testing or immunotherapy. This is a clinical pathology/medicine service typically performed in an allergy clinic or physician office with appropriate laboratory or compounding facilities where allergenic extracts are prepared for subsequent administration.
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’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.