How to Bill and Use CPT Code 99214 Properly
June 18, 2025
How CPT Code 95004 Impacts Allergy Testing, Billing & Reimbursement
If you’ve ever had itchy eyes, a runny nose, or seasonal sneezing fits, your doctor may have ordered an allergy test. But behind that test lies a web of coding and billing—especially when it involves CPT Code 95004. Whether you’re a provider, billing specialist, or a curious patient, this guide breaks it all down.
In this article, we’ll explore:
- The definition and use of CPT Code 95004
- Its relationship with other codes like 95024 and 95165
- Cost and Medicare coverage
- How modifiers, units, and billing nuances affect reimbursement
What Is CPT Code 95004?
CPT Code 95004 refers to percutaneous (stab or pinhole) allergy testing. This involves introducing a small amount of allergen on or under the skin’s surface to observe any reaction. It’s commonly used for:
- Environmental allergens (pollen, dust, mold)
- Food allergens
- Animal dander
Each prick test represents one unit of CPT code 95004. So, if a provider performs 20 different allergen tests, you’d bill 95004 x 20.
CPT Code 95004 Description & Billing Breakdown
- CPT 95004 Definition:
Percutaneous tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests. - 95004 CPT Code Description in Practice:
Let’s say Dr. Smith performs 15 skin prick tests for a patient with suspected seasonal allergies. She documents reactions, interprets results, and provides a treatment plan. The correct billing would be:
95004 x 15 units - 95004 CPT Code Modifier:
Modifiers are generally not required unless multiple allergy test types are performed in one session. If paired with CPT code 95024 (intradermal testing), you might use modifier -59 to indicate a distinct procedure.
CPT Code 95004 and 95024 - What’s the Difference?
Many confuse 95004 with CPT Code 95024. Here’s a simple comparison:
Code | Type of Test | Description |
95004 | Percutaneous (Prick) | Surface-level skin tests using allergen drops |
95024 | Intradermal (Injection) | Injecting allergens deeper into the skin |
If both codes are billed on the same day, make sure to distinguish them with documentation and modifiers.
95004 CPT Code Cost & Reimbursement - What to Expect
- Typical Cost:
The 95004 CPT code cost varies depending on location, provider, and insurance. On average:- Private reimbursement: $5 to $15 per allergen test
- Medicare reimbursement: ~$2 to $4 per test
- Is CPT Code 95004 Covered by Medicare?
Yes, but only if medically necessary. You must document symptoms like asthma, chronic rhinitis, or eczema. Coverage also depends on ICD-10 pairing. - Real Billing Tip:
A provider billing 95004 x 7 (seven tests) might receive $28 from Medicare and $50–$80 from commercial insurers, depending on the contract.
95004 CPT Code Units & Limits
- How many units can you bill?
There’s no fixed limit, but Medicare and many payers flag unusually high volumes. Billing more than 70–80 units may trigger audits. - Example Scenario:
A patient undergoes 50 skin tests (allergen panel). The bill would read:
95004 x 50
Ensure your documentation supports medical necessity and clearly outlines each tested allergen.
How CPT Code 95165 Fits In
CPT Code 95165 comes into play after allergy testing when the provider prepares treatment extracts (allergy shots). This code is not for diagnosis—it’s for immunotherapy preparation and is billed per dose.
Quick Comparison:
Code | Use |
95004 | Testing allergen reactions |
95165 | Preparing allergen immunotherapy doses |
Â
Humanized Insight - Billing Allergy Testing the Right Way
Working in medical billing, we’ve seen common mistakes:
- Billing 95004 minus listing the number of tests
- Forgetting to document medical necessity for Medicare
- Pairing the wrong ICD-10 codes
- Skipping modifiers when combining tests
One provider we worked with consistently under billed allergy testing. After auditing their charts, we realized they weren’t counting all tests in multi-panel exams. By correcting this, they increased revenue by over 35% within 3 months.
Final Thoughts
If your clinic offers allergy testing, CPT Code 95004 is a foundational part of your medical billing process. But like any code, it must be handled carefully:
- Know the limits and costs
- Use the right modifiers and units
- Ensure clear documentation
- Association with 95024 or 95165 only when appropriate
When used properly, it leads to faster payments, fewer denials, and better patient care.
At Express Medical Billing, we specialize in accurate allergy test coding, helping providers capture every dollar they’ve earned. Whether you’re confused about 95004 CPT code modifiers or struggling with Medicare documentation, our expert billing team can step in.
Frequently Asked Questions (FAQs)
CPT Code 95004 is used for allergy skin stab testing. It helps determine if a person is allergic to substances like pollen, dust, pet dander, or foods. Each "unit" of 95004 represents one allergen tested using a small skin prick.
There’s no strict universal limit, but most insurance payers including Medicare will flag unusually high quantities. Typically, billing up to 70–80 units is considered acceptable if medically justified. Always document the number of allergens tested.
Yes, Medicare does cover CPT Code 95004, but only when it's medically necessary. Common ICD-10 codes that justify its use include J30.1 (Allergic rhinitis) or L23.9 (Contact dermatitis). Be sure the patient has documented symptoms.
- 95004 is for prick/puncture tests on the skin’s surface.
- 95024 is for intradermal tests, where the allergen is injected deeper into the skin.
If both are performed on the same day, use appropriate modifiers and document clearly.
Reimbursement varies:
- Medicare typically reimburses $2–$4 per test.
- Private insurers may pay $5–$15 per test, depending on your region and contract.
So, 95004 x 10 units could yield anywhere from $20 to $150+, depending on the payer.
Yes, but not for the same procedure.
- 95004 is for testing.
- 95165 is for preparing allergy shots (immunotherapy).
They often go hand-in-hand in allergy clinics but must be used in different stages of treatment.
If you're billing multiple types of allergy tests on the same day (like 95004 and 95024), you may need Modifier 59 to show they’re distinct procedures. However, 95004 alone typically doesn’t need a modifier.
