CPT code 95131: Venom immunotherapy, two insect venoms2026 Medicare rate & RVUs in Texas
A venom-allergy immunotherapy visit addressing two stinging-insect venoms; Medicare does not accept 95131 and uses a different code for reporting and payment.
CMS doesn’t publish an office rate for 95131 in Texas.
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 95131 covers
95131 identifies a venom-allergy immunotherapy visit involving two stinging-insect venoms. An allergy specialist reports it for treatment administered during a patient's care for insect-venom allergy. The code distinguishes the visit by the number of venoms addressed, rather than by the count of injections. It is separate from codes describing preparation and provision of allergen extracts.
Medicare assigns status I to 95131: Medicare does not accept this CPT code and uses a different code to report and pay for the service. Within the CPT venom-immunotherapy family, the neighboring codes distinguish visits by the number of stinging-insect venoms involved. Antigen preparation and provision are represented separately from the venom-immunotherapy visit.
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 95131 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | Unavailable |
| Beaumont, TX | Unavailable | Unavailable |
| Brazoria, TX | Unavailable | Unavailable |
| Dallas, TX | Unavailable | Unavailable |
| Fort Worth, TX | Unavailable | Unavailable |
| Galveston, TX | Unavailable | Unavailable |
| Houston, TX | Unavailable | Unavailable |
| Rest of Texas | Unavailable | Unavailable |
How the 95131 rate is calculated
Each of 95131’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 · 95131
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 95131
95131 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 · 95131
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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95131 isn’t priced in this setting.
95131 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95130Venom immunotherapyOne insect venom
- 95130 identifies a visit involving one stinging-insect venom; 95131 identifies a visit involving two.
- 95132Venom immunotherapyThree venoms
- 95132 identifies a visit involving three stinging-insect venoms; 95131 identifies a visit involving two.
- 95117Allergy shotsTwo or more injections, extract not included
- 95117 describes allergen immunotherapy involving two or more injections. 95131 distinguishes venom immunotherapy by the number of stinging-insect venoms.
- 95146Venom antigen preparationTwo venom types
- 95146 concerns antigen preparation and provision for two stinging-insect venoms; 95131 identifies the venom-immunotherapy visit.
95131 billing questions
When is 95131 selected instead of 95130 or 95132?
95131 identifies a visit involving two stinging-insect venoms. 95130 is for one, and 95132 is for three.
Is 95131 valid for Medicare claims?
No. Medicare assigns status I to 95131 and uses a different code to report and pay for the service.
Does 95131 include venom extract preparation and provision?
No. The venom-immunotherapy visit is separate from codes for antigen preparation and provision.
How are units determined?
The code identifies a visit involving two stinging-insect venoms; it is not selected by counting injections alone.
What should the record support?
Document the venom immunotherapy provided and identify the two stinging-insect venoms involved.
How does 95131 differ from 95117?
95131 distinguishes a venom-immunotherapy visit by the number of stinging-insect venoms. 95117 describes allergen immunotherapy involving two or more injections.
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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