CPT 95165
Global XXX ActiveAntigen therapy services
CPT 95165 Billing & Documentation Guide
CPT code 95165 (Antigen therapy services) is classified under Allergy/Immunology with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.06, a non-facility practice expense RVU of 0.45, and a malpractice RVU of 0.01, a total non-facility RVU of 0.52 and facility RVU of 0.08. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $18.02, though rates vary from $15.09 to $24.08 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95165, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 95165 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 30 units of 95165 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 95165
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.06 | 0.06 |
| Practice Expense RVU | 0.45 | 0.01 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.52 | 0.08 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95165
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $20.04 | $2.65 | $18.69 - $24.08 | 29 |
| Florida | $17.74 | $2.99 | $16.88 - $18.5 | 3 |
| Georgia | $16.75 | $2.73 | $15.81 - $17.68 | 2 |
| Illinois | $17.17 | $2.97 | $16.25 - $18.05 | 4 |
| Michigan | $16.59 | $2.79 | $16.1 - $17.07 | 2 |
| North Carolina | $16.24 | $2.53 | $16.24 - $16.24 | 1 |
| New York | $19.32 | $2.93 | $16.52 - $20.62 | 5 |
| Ohio | $16.06 | $2.65 | $16.06 - $16.06 | 1 |
| Pennsylvania | $17.11 | $2.71 | $16.12 - $18.09 | 2 |
| Texas | $17.12 | $2.65 | $15.99 - $18.21 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 95165
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95165 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0405T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0591T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0592T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0593T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0776T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 90760 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 95165
What does CPT code 95165 mean? +
CPT code 95165 represents: Antigen therapy services. It's in the Allergy/Immunology category with a global period of XXX.
What is the Medicare reimbursement for CPT 95165? +
The 2026 Medicare national average non-facility payment for CPT 95165 is $18.02. Rates range from $15.09 to $24.08 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95165? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 95165? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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