Billing code 95145: Venom antigenMedicare rate & RVUs in Oregon
Reports supervision of preparing and providing one stinging-insect venom antigen for allergen immunotherapy, counted by the doses prepared and supplied.
Medicare pays $33.84–$37.54 for 95145 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 95145 covers
An allergist or allergy practice reports this service for supervising preparation and provision of a single stinging-insect venom antigen used in immunotherapy. A typical case is venom treatment for a patient with a systemic reaction to a specific insect sting, such as a honeybee or yellow jacket. This code represents the antigen service, not the injection itself.
Select the one-venom level based on the antigen supplied, and report units for the doses prepared and provided rather than the number of injections administered. Documentation should identify the venom antigen, the dose quantity prepared or supplied, and the immunotherapy plan. CMS values the service under the physician fee schedule using work, practice expense, and malpractice RVUs; its practice-expense allocation is much higher in the office setting than in a facility. No additional payment rule is identified in the supplied CMS facts.
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 95145 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $37.54 | $2.66 |
| Rest Of Oregon | $33.84 | $2.57 |
How the 95145 rate is calculated
Each of 95145’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 · 95145
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.06Practice expense 0.95Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95145
95145 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 · 95145
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$34.07
The facility rate would be $2.67 (+$31.40). In a facility, the facility bills its own costs separately.
95145 compared with similar codes
Compare codes
95145 vs 95146 vs 95165 vs 95130: national Medicare rates
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How to choose
- 95146Venom antigen preparation
- 95145 covers preparation and provision for one single stinging-insect venom; 95146 is for two single venoms.
- 95165Allergy extract preparation
- 95165 covers single or multiple antigens counted per dose. 95145 is the specific level for one single stinging-insect venom.
- 95130Immntx 1 sting insect
- 95130 reports the professional service for venom immunotherapy involving one insect. 95145 reports supervision of preparing and providing the venom antigen, counted by dose.
95145 billing questions
When is 95145 used instead of 95146?
Use 95145 for one single stinging-insect venom antigen. Use 95146 when the preparation and provision covers two single venoms.
Are units based on injections or doses?
Units represent doses of antigen prepared and provided, not the number of injections administered. Keep the dose quantity supported by the preparation and supply record.
Does 95145 report the injection?
No. It reports supervision of antigen preparation and provision. Injection services are represented by separate immunotherapy service codes when applicable.
What documentation supports this code?
Record the specific venom antigen, the number of doses prepared or supplied, and the patient's immunotherapy plan. The record should support why the one-venom level was selected.
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
Show the CMS file lines behind this rate
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