Allergy Testing - CPT 95004 - 95078

Allergy Testing - CPT 95004 - 95078

1. The MPFSDB fee amounts for allergy testing services billed under codes 95004-95078 are established for single tests. Therefore, the number of tests must be shown on the claim. EXAMPLE If a physician performs 25 percutaneous tests (scratch, puncture, or prick) with allergenic extract, the physician must bill code 95004 and specify 25 in the units field of Form CMS-1500 (paper claims or electronic format). To compute payment, the Medicare carrier multiplies the payment for one test (i.e., the payment listed in the fee schedule) by the quantity listed in the units field.

2. Part B providers indicate the number of tests (one for each antigen) in Box 24G of the HCFA 1500 claim form. On EMC claims enter the number in the service field.

3.  Interpretation of CPT codes: 95004 -95078; use the code number which includes the number of tests which were performed and enter 1 unit for each test performed. For example, if 18 scratch tests are done, code 95004 with 18 like services. If 36 are done, code 95004 with 36 like services.

4. When photo patch tests (e.g. CPT code 95052) are performed (same antigen/same session) with patch or application tests, only the photo patch testing should be reported. Additionally, if photo testing is performed including application or patch testing, the code for photo patch testing (CPT code 95052) is to be reported, not CPT code 95044 (patch or application tests) and CPT code 95056 (photo tests).

5. Non-covered testing: Non-covered services include, but are not limited to, the following services (some are not represented by specific CPT-4 codes). Some of these are based on statute and this is noted in italics.