How much does Medicare pay for CPT 95165?

Medicare allowed an average of $13.88 per service and paid $10.42 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $29.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95165?

Professional service for preparation and provision of 1 or more antigens. It was billed 5,235,816 times to 167,531 Medicare beneficiaries by 3,124 providers in 2024.

Does 95165 pay differently in an office than a hospital?

Yes. The allowed amount averaged $13.89 in an office setting and $3.21 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95165 most?

Allergy/ Immunology, with 3,077,146 services from 1,695 clinicians. Next are Otolaryngology, Internal Medicine, Nurse Practitioner.

CPT 95165

Professional service for preparation and provision of 1 or more antigens

$13.88Medicare-allowed amount per service, averaged across 5,235,816 services

Providers submitted

$29.15

Asking price, not received

Medicare allowed

$13.88

The fee schedule figure

Medicare paid

$10.42

Balance is patient coinsurance

Providers submitted an average of $29.15 for this code and Medicare allowed $13.88 — 2.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $10.42 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $13.89
Hospital / facility: $3.21

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,228,820 services were billed in an office setting and 6,997 in a facility.

Services: 5,235,816
Beneficiaries: 167,531
Providers billing it: 3,124
Total allowed: $72,673,126

What Medicare pays for CPT 95165

Across 5,235,816 services billed by 3,124 providers to 167,531 beneficiaries, Medicare allowed an average of $13.88 per service. That is 31.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95165

Specialty	Services	Beneficiaries	Avg allowed	Providers
Allergy/ Immunology	3,077,146	109,278	$14.11	1,695
Otolaryngology	1,377,340	45,377	$13.53	1,026
Internal Medicine	213,590	3,655	$14.52	85
Nurse Practitioner	211,443	3,210	$11.77	111
Family Practice	150,770	2,028	$13.89	74
Pulmonary Disease	45,389	860	$14.26	33
Physician Assistant	26,611	969	$12.32	41
Pediatric Medicine	26,129	829	$13.90	23
Rheumatology	21,413	482	$13.71	6
Physical Medicine and Rehabilitation	14,462	105	$14.14	1
Orthopedic Surgery	12,800	43	$16.75	1
General Practice	10,195	83	$15.19	2
Pain Management	9,903	36	$13.42	3
Dermatology	7,619	137	$14.24	5
Interventional Pain Management	7,130	24	$14.06	2

95165 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Texas	662,903	$13.71	$10.89	369
California	445,411	$16.18	$11.04	209
Florida	370,614	$14.16	$10.92	224
Tennessee	304,154	$12.74	$10.64	129
Arizona	301,296	$13.21	$10.63	87
Virginia	270,490	$14.09	$10.82	123
New York	244,944	$15.96	$10.88	137
Pennsylvania	209,581	$13.82	$10.76	144
South Carolina	189,102	$12.94	$10.69	92
Kentucky	176,310	$12.69	$10.67	79
North Carolina	155,042	$13.27	$10.62	132
New Jersey	139,065	$16.01	$10.95	81
Ohio	124,966	$13.11	$10.54	82
Oklahoma	111,772	$12.77	$10.63	39
Georgia	110,022	$13.14	$10.87	81
Missouri	98,479	$12.65	$10.51	80
Alabama	94,737	$12.38	$10.62	70
Massachusetts	93,861	$14.78	$10.67	55
Michigan	93,486	$13.68	$10.59	92
Maryland	89,126	$15.29	$10.85	58
Illinois	85,570	$14.07	$10.50	81
Indiana	83,886	$13.05	$10.43	75
Louisiana	80,895	$12.87	$10.72	61
Colorado	75,328	$14.19	$10.61	42
Arkansas	64,327	$12.26	$10.76	43
Kansas	59,676	$12.70	$10.53	41
Mississippi	57,159	$11.91	$10.43	35
Washington	54,307	$15.13	$10.82	45
New Mexico	50,810	$13.05	$10.79	18
Nevada	45,345	$13.93	$10.92	19
West Virginia	41,079	$12.15	$10.53	22
Iowa	32,047	$12.36	$10.22	27
Oregon	28,203	$14.34	$10.91	28
Delaware	26,487	$14.12	$10.53	14
Nebraska	21,482	$13.06	$10.36	25
Connecticut	20,868	$15.44	$10.80	26
Utah	19,645	$13.46	$10.77	21
New Hampshire	12,412	$14.27	$10.22	14
District of Columbia	12,304	$15.87	$11.10	5
Minnesota	11,777	$13.18	$10.09	19
Rhode Island	10,874	$14.76	$10.67	13
Idaho	10,634	$12.94	$10.34	18
Wyoming	10,374	$14.00	$10.68	8
Wisconsin	8,826	$13.57	$10.41	19
Montana	7,859	$11.41	$8.49	8
South Dakota	7,100	$11.45	$8.67	14
Maine	3,220	$15.83	$10.51	4
Hawaii	2,412	$15.61	$11.17	3
Puerto Rico	1,784	$14.38	$10.49	2
North Dakota	1,266	$8.68	$6.80	4
Vermont	1,255	$13.98	$10.77	2
Alaska	1,245	$15.21	$10.21	5

Related codes

95117Professional service for multiple injections of allergen$11.66
95115Professional service for single injection of allergen$9.48
95144Professional service for preparation and provision of single-dose vial$15.85
95180Injection for rapid desensitization to allergen$136.44
95170Professional service for preparation and provision of whole body extra$10.50
95148Professional service for preparation and provision of 4 stinging insec$89.39
95149Professional service for preparation and provision of 5 stinging insec$118.84

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.