Billing code 95115: Allergy shotMedicare rate & RVUs in Washington
Administration of one subcutaneous allergen immunotherapy injection during an encounter, reported separately from any preparation and supply of the allergenic extract.
Medicare pays $10.81–$12.57 for 95115 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 95115 covers
This service is the administration of one allergy shot, usually into the upper arm, during a build-up or maintenance schedule. Staff observe the patient for a reaction after the injection. Nurses or medical assistants commonly administer shots in allergy, ENT, and primary care offices under a physician’s treatment plan. The extract may have been prepared by that practice or supplied by another allergy practice.
Report one unit for an encounter in which one allergen immunotherapy injection is given; use 95117 when two or more are given during the encounter. The administration code excludes preparation and supply of the extract, which may be reported separately when performed and supported. Document the extract or vial, dose, concentration, injection site, observation, and any reaction. CMS classifies this as an incident-to service, payable only when performed under physician supervision; its physician work RVU is zero. For Medicare, use the separate administration and extract preparation codes rather than the combined injection-and-extract codes.
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 95115 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $10.81 | Unavailable |
| Seattle (King Cnty) | $12.57 | Unavailable |
How the 95115 rate is calculated
Each of 95115’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 · 95115
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.00Practice expense 0.30Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95115
The CMS indicators that decide how 95115 is paid alongside other services.
CMS payment indicators · 95115
Allergy shot
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
95115 compared with similar codes
Compare codes
95115 vs 95117 vs 95120 vs 96372 vs 95165: national Medicare rates
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How to choose
- 95117Allergy shots
- 95115 is for one allergen immunotherapy injection during an encounter; 95117 is for two or more. Do not bill 95115 per injection when 95117 describes the injections given.
- 95120Immunotherapy one injection
- 95120 combines a single injection with provision of the extract. Medicare uses 95115 for the administration and a separate preparation code when extract preparation is performed and reportable.
- 96372SC/IM injection
- 96372 describes administration of a therapeutic or prophylactic substance. Use 95115, rather than 96372, for one subcutaneous allergen immunotherapy injection.
- 95165Allergy extract preparation
- 95165 describes preparation and provision of immunotherapy extract doses; 95115 describes administering one injection. Preparation may take place on a different date from the shot.
95115 billing questions
When should 95117 be reported instead of 95115?
Use 95117 when two or more allergen immunotherapy injections are given during an encounter, such as injections from separate vials. Do not report one unit of 95115 for each shot or report both codes for the same set of injections.
Does 95115 include the allergenic extract?
No. It covers administration of the injection. Preparation and supply may be reported separately when performed and documented, such as with 95165 for doses prepared for immunotherapy.
Can an E/M visit be billed on the same day as an allergy shot?
A significant, separately identifiable E/M service beyond the routine pre-injection check may be reported with modifier 25 on the E/M code. Do not separately report 99211 solely for the routine check before the shot.
Who can perform the injection for Medicare billing?
Clinical staff such as nurses or medical assistants commonly administer it. CMS treats 95115 as an incident-to service, so physician supervision requirements must be met.
Should 96372 be used for allergy shots?
No. Allergen immunotherapy injections have dedicated administration codes: 95115 for one injection and 95117 for two or more during an encounter.
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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