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CPT code 95130: Venom immunotherapy, one insect venom2026 Medicare rate & RVUs

Professional allergen immunotherapy for one stinging-insect venom, including the extract, is reported when venom-allergy treatment is provided in an office or institution.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 95130

Venom immunotherapy, one insect venom

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 95130 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 95130 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 95130 covers

This service covers allergen immunotherapy for sensitivity to venom from one type of stinging insect. An allergist or other clinician providing venom immunotherapy reports the treatment service, which includes the allergenic extract as well as the immunotherapy service. The code distinguishes treatment by the number of venom types, not by the number of injections given during a visit. It is used in the prescribing physician's office or an institution.

For Medicare, status I means this CPT code is not valid for Medicare reporting; Medicare uses a different code for the service. For coding within this family, select the code that matches the number of stinging-insect venom types used. The one-venom code is distinct from codes for two or more venom types and from codes describing allergen immunotherapy services that do not include the extract.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 95130 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

95130 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

95130 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
95130 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 95130 rate is calculated

Each of 95130’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 95130

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 95130

95130 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 95130

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

95130 isn’t priced in this setting.

95130 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 95130

    Venom immunotherapy, one insect venom0 wRVU

    Not priced

  • 95131

    Venom immunotherapy, two insect venoms0 wRVU

    Not priced

  • 95115

    Allergy shot, single injection, extract not included0 wRVU

    $10.35

  • 95145

    Venom antigen, one insect venom0.06 wRVU

    $34.07

How to choose

95131Venom immunotherapyTwo insect venoms
Use 95130 for one stinging-insect venom type and 95131 for two. The distinction is the number of venom types, not injection count.
95115Allergy shotSingle injection, extract not included
95115 describes a single allergen immunotherapy injection without the extract. 95130 is specific to one stinging-insect venom and includes the extract.
95145Venom antigenOne insect venom
95145 describes supervision of antigen preparation and provision for one stinging-insect venom. 95130 describes the immunotherapy service that includes the extract.

Codes related to 95130

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 95130
CodeHow it relatesNational office range
Same family
95131Venom immunotherapy, two insect venomsSibling code for immunotherapy using two types of stinging-insect venom.No office rate
95132Venom immunotherapy, three venomsSibling code for immunotherapy using three types of stinging-insect venom.No office rate
95133Insect immunotherapy, four stinging insectsSibling code for immunotherapy using four types of stinging-insect venom.No office rate
95134Venom immunotherapy, five insect typesSibling code for immunotherapy using five types of stinging-insect venom.No office rate
Used instead
95115Allergy shot, single injection, extract not includedAllergen immunotherapy without provision of the extract, for a single injection.$8.78–$14.63
95117Allergy shots, two or more injections, extract not includedAllergen immunotherapy without provision of the extract, for two or more injections.$10.50–$17.52

95130 billing questions

Does 95130 mean one injection?

No. It identifies immunotherapy involving one type of stinging-insect venom; the code is not selected by counting injections.

How does 95130 differ from 95131?

95130 applies when treatment uses one type of stinging-insect venom. 95131 is the sibling code for two venom types.

Is the allergenic extract included?

Yes. This service includes the allergenic extract along with the immunotherapy service.

Can 95130 be reported to Medicare?

No. Medicare assigns status I to 95130, meaning it is not valid for Medicare reporting; Medicare uses a different code for the service.

What should the record support?

Document the venom immunotherapy provided and the number of stinging-insect venom types used, since the number distinguishes codes in this family.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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