Below are the official descriptions and billing guidelines of all the CPT codes used for allergy testing.
1. CPT Code 95004
Bill CPT 95004 when a health provider performed percutaneous tests with allergenic extracts to determine substances that cause allergic reactions.
The 95004 CPT code is officially defined in the book of CPT as: “Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify the number of tests.”
During the 95004 CPT code procedure, a provider introduces small amounts of different allergens into the epidermis and non–vascular superficial dermis through scratches, punctures, or pricks on the skin.
After a predetermined interval (e.g., 15 minutes), the provider visually checked the target area for any visible wheal and flare reaction, indicating that a person may or may not be allergic to the particular allergen.
The tests are finally interpreted, and reports are made.
1.3 Billing Guidelines
You can not include testing of negative or positive controls in the number of reported tests. This is because they are not separately billable by Medicare. After all, they are included in the medical supply.
2. CPT Code 95012
CPT 95012 can be reported for tests performed by a health provider which involve the exhalation of nitric oxide by a patient into a nitric oxide monitoring system. This is done to check inflammation levels in the patient’s airways to confirm an airway inflammation disease (for example, bronchial asthma)
The 95012 CPT code is defined by the manual of CPT as follows: “Nitric oxide expired gas determination.”
The procedure described by CPT 95012 starts with a provider instructing a patient to inhale air free of nitric oxide to the maximum of what the patient can inhale. Then he asks the patient to exhale the air into a nitric oxide monitoring system immediately.
The provider measures the amount of nitric oxide that the patient exhales. The provider performs this test before and after a patient has started anti-inflammatory treatment for confirmed or suspected inflammatory diseases of the airway.
The provider performs this test to check whether the anti-inflammatory treatment the patient is taking is appropriate.
The provider also checks whether the patient’s asthma is under control. He uses the test results to know how much inflammation is still left in the patient’s airway and to judge the patient’s response to therapy. Based on the results, the provider adjusts the dose of anti-inflammatory treatment.
3. CPT Code 95017
CPT 95017 reports allergy testing with many different types of allergy tests. You can bill this code for intradermal, prick, puncture, scratch, and other tests. These tests include venoms and can be performed incrementally and sequentially.
The 95017 CPT code is described by Current Procedural Terminology as: “Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify the number of tests.”
The procedure described by CPT 95017 can be performed with two types;
- percutaneous and intracutaneous, or;
3.2.1 Percutaneous Test
This technique uses a drop of solution containing a possible allergen (venom) on the skin. Then, a needle performs a series of scratches or pricks, allowing the solution to enter the skin.
If the skin develops a red, raised, itchy area, it indicates that the person is allergic to that allergen. Usually, the reaction takes place almost immediately.
3.2.2 Intracutaneous Or Intradermal Test
The intradermal test is performed when a substance does not cause a reaction in the skin prick test but is still suspected as an allergen (venom) for that person.
A small amount of the allergen solution is injected into the skin’s deeper layers, producing an allergic response if the person is allergic to that substance.
4. CPT Code 95024
CPT 95024 may be reported when a health provider introduces allergenic extracts into the patient’s skin to determine an immediate allergic response. The response is interpreted, and the results are reported.
The 95024 CPT code can be found in the manual of CPT and is as follows: “Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify the number of tests.”
In the 95024 CPT code procedure, the provider introduces small amounts of different allergens into the epidermis and nonvascular superficial dermis through intracutaneous (intradermal) injections.
After a predetermined interval (15 minutes, for example), the area is visually checked for any visible allergic reaction, indicating that a person may or may not be allergic to the particular allergen. The results are interpreted and reported. The report should specify the number of tests.
An allergic reaction results from the body’s response to a specific substance that otherwise seems relatively harmless but can cause a severe reaction in a person allergic to the substance.
When an allergen (the allergic substance) enters the body, the white blood cells produce an antibody called IgE (immunoglobulin E) that attacks and sticks to the allergen. This results in the release of histamine and other chemicals that cause an inflammatory response in the person and produce redness, swelling, and sometimes, itching.
4.3 Billing Guidelines
The descriptors for CPT 95024 and CPT 95027 look similar; the difference is that CPT 95027 may employ four or five dilutions of increasing concentration.
5. CPT Code 95027
You can use CPT 95027 for a test in which a provider introduced incremental and sequential allergenic extracts into the patient’s skin to determine an immediate allergic response.
CPT code 95027 is described by the CPT manual as: “Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify the number of tests.”
In the 95027 CPT code procedure, small amounts of airborne allergens or extracts are introduced into the epidermis and nonvascular superficial dermis through intracutaneous (intradermal) injections.
This test method analyzes the highest dilution of a substance that produces a reaction with a given concentration of another substance.
Immediately, the provider visually checks the area for any visible allergic reaction, which indicates that a person may or may not be allergic to the particular allergen. The results are interpreted and reported. The number of tests should be specified.
6. CPT Code 95028
CPT 95028 can be billed when a provided introduced allergenic extract into the patient’s skin. This is done to determine delayed allergic responses. The results are interpreted, and a report with the number of tests is specified.
The official description of CPT 95028 is: “Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify the number of tests.”
The provider injects the patient’s skin with specific allergenic extracts. The response to these extracts is expected to be delayed; therefore, the application sites are usually on the patient’s back.
The patient returns in a few days for the provider to evaluate the reaction. Once a reply has occurred, it is measured and documented. This code includes interpretation and report. The number of tests should be specified.
7. CPT Code 95044
Report CPT 95044 when a provider performed patch testing to determine an allergic reaction.
The 95044 CPT code is officially defined in the CPT book as follows: “Patch or application test(s) (specify the number of tests).”
The 95044 CPT code procedure starts with a provider labeling the patch testing areas on the skin.
They then apply a patch containing a group of related test substances to the labeled area, usually on the upper back. The patches are left on for at least 48 hours.
After 48 hours, the provider removes the patches, examines the skin, and documents the patient’s allergic reaction to one or multiple substances (in the patch) in the report. The physician also mentions the number of tests in the report.
8. CPT Code 95052
CPT 95052 is part of the medicine section and can be used for a photo test in conjunction with a patch test.
The 95052 CPT code is defined as: “Photo patch test(s) (specify the number of tests).”
The CPT 95052 procedure starts with a patch containing allergy placed by the physician onto the patient’s arm and is exposed to ultraviolet light. Afterward, the patient’s skin or anaphylactic reaction is noted to uncover specific allergies.
8.3 Billing Guidelines
CPT 95052 requires the physician’s direct supervision in case the patient has an anaphylactic reaction to a test.
9. CPT Code 95056
CPT is also in the Medicine section and can be used for photo tests.
The book of CPT defines the description of CPT code 95056 as: “Photo tests.”
During the 95056 CPT code procedure, the patient’s skin is exposed to ultraviolet light by a physician, and the skin’s reaction or anaphylactic reaction is noted to uncover specific allergies.
10. CPT Code 95060
Report CPT 95060 for an allergy testing procedure of a patient’s eye. These tests are often used to determine which allergens cause and reaction and the degree of it.
CPT defines the 95060 CPT code as: “Ophthalmic mucous membrane tests.”
CPT code 95060 represents the technical component of a service in which the provider conducts an ophthalmic or eye mucus membrane test by introducing an allergenic extract into the conjunctiva or the eye’s inner lining.
He then observes the patient’s eye for redness and itching. The elasticity of the eye’s conjunctiva helps the eyelid and eyeball to move.
The provider conducts this test and records the results, as this helps the provider to determine which medicines he should recommend to the patient.
10.3 Billing Guidelines
CPT code 95060 represents the technical component of the service only, so you should not append modifier 26 or modifier TC.
You should not use CPT 95060 for Schirmer’s tear testing, which payers typically include in the office visit or eye exam code.
11. CPT Code 95065
Report CPT 95065 for allergy tests of the nasal mucus membrane of a patient. The kind of allergic reaction and the degree of can be determined with this test.
The 95065 CPT code is officially described by the CPT book as: “Direct nasal mucous membrane test.”
CPT code 95065 represents the technical component of a service in which the provider checks the inner lining of the patient’s nasal cavity for any significant allergic reactions.
They conduct this test by introducing an allergenic extract into the inner lining of the nose. This test provides data on changes in nasal airway resistance.
11.3 Billing Guidelines
CPT code 95065 represents the technical component of the service only, so you should not append modifier 26 or modifier TC.
12. CPT Code 95070
CPT 95071 can be reported when a provider uses a bronchial challenge test. This test is also known as a methacholine challenge or histamine challenge. It is used to diagnose asthma.
The official definition of the 95070 CPT code is described by CPT’s book as: “Inhalation bronchial challenge testing (not including necessary pulmonary function tests), with histamine, methacholine, or similar compounds.”
The 95070 CPT code represents the technical component of a service in which the provider uses chemicals to perform a test when the patient has a specific allergy.
The provider uses histamine, methacholine, or similar compounds to detect how the airways respond.
These compounds constrict the bronchioles, tubes through which air passes from the nose to the lungs after a person breathes.
The provider allows the patient to inhale the substance to which the patient is in frequent exposure and checks if the patient is allergic to it.
The provider then records the allergic reaction, which includes further contraction of the bronchioles, reflecting the changes in the inhalational capacity of the patient.
12.3 Billing Guidelines
This test does not include pulmonary function tests, such as CPT 94060 and CPT 94070. Instead, the provider prepares a report after he finishes doing the test.
CPT code 95070 represents the technical component of the service only, so you should not append modifier 26 or modifier TC.
This code does not include payment for the pulmonary function tests required to evaluate the patient’s prolonged post-exposure bronchospasm, so you should report codes such as CPT 94070 in addition to CPT 95070.
13. CPT Code 95076
CPT 95076 is a procedure where a provider performs tests to identify what kind of drugs, food, or substances trigger an allergic reaction in a patient.
The official descriptor of CPT 95076 can be found in CPT’s book and is as follows: “Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); initial 120 minutes of testing.”
In the 95076 CPT code test procedure, the provider supplies the patient with a particular food, drug, or other substance, which he carefully plans to test the patient for the allergen.
Next, the patient tastes the food, and the provider observes him for allergic symptoms. If symptoms appear, the test ends, and the provider confirms that the particular allergen is a cause of hypersensitivity to the patient.
But if no symptom is apparent and enough time passes without any reaction, the provider confirms that the particular food is safe for consumption by the patient.
During the 95076 CPT code procedure, the provider slowly and sequentially increases the amount of the food or drug the patient ingests to determine if a substance causes an allergic reaction when the patient eats the food in a larger quantity only or cases of multiple substances testing, in combination with another item.
13.3 Billing Guidelines
Use CPT code 95076 for allergic response testing, initial 120 minutes after sequential and incremental ingestion.
Use code CPT 95076 one time per patient encounter, regardless of the number of items the provider tests.
- CPT Code 95079
CPT 95079 is an add-on code and can be billed for each additional 60 minutes of an Ingestion challenge test.
The official description of this add-on code is: “Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); each additional 60 minutes of testing (List separately in addition to code for primary procedure).”
14.2 Billing Guidelines
Because CPT code 95079 is an add-on code, payers will not reimburse you if you report it without an appropriate primary code. See CPT 95076 for the initial 120 minutes of testing.