$17.05
95170 includes provision of a whole-body extract. 95165 covers antigen services that exclude provision of allergenic extracts.
On this page
CMS RVU26D · Effective 2026-10-01
95170 Allergen therapy Medicare reimbursement rates in Vermont
Report one unit for physician-supervised allergen immunotherapy involving provision of a whole-body extract, such as an insect extract, in the prescribing practice. Compare 95170 office and facility rates across CMS payment localities in Vermont.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 95170 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$10.44
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$2.50
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Allergy and immunology
About 95170: Whole-body allergen immunotherapy dose
Report one unit for physician-supervised allergen immunotherapy involving provision of a whole-body extract, such as an insect extract, in the prescribing practice.
CPT 95170 represents allergen immunotherapy using a whole-body extract, with the extract provided as part of the service. Allergy specialists commonly use this approach for whole-body insect extracts, such as fire-ant extract. The service is associated with the prescribing physician’s practice or institution and supports treatment under an established allergy immunotherapy plan.
Report units that match the whole-body extract service documented for the patient. Records should identify the extract and connect its preparation or provision to the prescribed immunotherapy. The code includes the extract, unlike 95165, which describes antigen services that exclude provision of allergenic extracts. CMS assigns physician work and practice expense values to 95170 under the physician fee schedule; the code’s included extract is not a separate supply service within this code.
Where the value comes from
- Work RVU0.06 · 19%
- Practice expense (office) RVU0.25 · 78%
- Malpractice RVU0.01 · 3%
9K
Medicare services in 2024 · #1530 by national volume
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.
95170 compared with similar codes
Office rates for Vermont, from the same CMS release.
$20.69
95144 is associated with single-dose vial antigen services. Choose 95170 for a whole-body extract service.
$33.59
95145 is for antigen services involving one stinging-insect venom. 95170 describes whole-body extract immunotherapy.
95130
No office rateImmntx 1 sting insect
95130 covers office immunotherapy involving one stinging-insect venom. 95170 concerns a whole-body extract, not a venom-count service.
Compare 95170 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Vermont →
Office / nonfacility
$10.44
Facility
$2.50
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95170 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
12,488
- Code
- 95170
- Physician work
- 0.06
- Practice expense
- 0.25
- Malpractice
- 0.01
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.06 | × 1.000 | 0.0600 |
| Practice expense | 0.25 | × 0.990 | 0.2475 |
| Malpractice | 0.01 | × 0.506 | 0.0051 |
| Total RVUs | 0.3126 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$10.44
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.06 | 1 |
| Practice expense | 0.25 | 0.99 |
| Malpractice | 0.01 | 0.506 |
(0.06 × 1 + 0.25 × 0.99 + 0.01 × 0.506) × $33.4009 = $10.44
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.06 | 1 |
| Practice expense | 0.01 | 0.99 |
| Malpractice | 0.01 | 0.506 |
(0.06 × 1 + 0.01 × 0.99 + 0.01 × 0.506) × $33.4009 = $2.50
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
95170 billing questions
When should 95170 be chosen instead of 95165?
Use 95170 for allergen immunotherapy involving a whole-body extract that is provided as part of the service. Code 95165 is for antigen services that do not include provision of the allergenic extract.
Does 95170 include the allergenic extract?
Yes. The whole-body extract is part of the service represented by 95170.
Is 95170 counted by injection or by extract unit?
It is reported by unit for the whole-body extract service, not by counting the number of injections administered.
What documentation supports 95170?
Document the prescribed immunotherapy plan, the whole-body extract used, and the units provided. The record should make clear that the service involved a whole-body extract rather than a different antigen preparation.
How does 95170 differ from venom immunotherapy codes?
95170 is for whole-body extract immunotherapy. Codes such as 95145 identify antigen services for specific numbers of stinging-insect venoms.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,48595148,,Antigen therapy services,A,,0.06,2.60,,0.01,,0.01,2.67,0.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,48695149,,Antigen therapy services,A,,0.06,3.48,,0.01,,0.01,3.55,0.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,48795165,,Antigen therapy services,A,,0.06,0.45,,0.01,,0.01,0.52,0.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,48895170,,Antigen therapy services,A,,0.06,0.25,,0.01,,0.01,0.32,0.08,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,48995180,,Rapid desensitization,A,,2.01,2.04,,0.52,,0.07,4.12,2.60,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49095199,,Unlisted all/immlg svc/px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,49195249,,Cont gluc mntr pt prov eqp,A,,0.00,2.05,,2.05,NA,0.04,2.09,2.09,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817