CPT code 95130: Venom immunotherapy, one insect venom2026 Medicare rate & RVUs in Maryland
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 doesn’t publish an office rate for 95130 in Maryland.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | Unavailable |
| Rest of Maryland | Unavailable | Unavailable |
| Washington, DC area | Unavailable | Unavailable |
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
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
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95130 isn’t priced in this setting.
95130 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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