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See a sample rate comparisonCPT 95004 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Allergy Skin Tests, Test For Allergies To Pollen Animal Dander Drugs Or Other Substances. The Test Is Performed By Placing A Small Amount Of The Suspected Allergen Under The Skin And Monitoring To See If A Reaction Occurs.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Allergy and Clinical Immunology Procedures |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service 76 - Repeat procedure by same physician |
| Complexity Level | Low |
| Medicare Fee Schedule | $3.67 national non-facility rate (2026) · View Medicare rates for 95004 |
| Medicaid Fee Schedule | $2.95 median of the 8 states in the free preview · View Medicaid rates for 95004 |
National average reimbursement for CPT 95004 by major payers:
$5.53
$7.56
$6.49
$6.60
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CPT 95004
5 of 25 sample ratesHigher to lower in this preview
Jyothi Tirumalasetty
$22.61Published rateElena Reece
Howard University
$9.28Published rateAma Alexis
Kmp Medical, PLLC
$5.07Published rateJames Wolfe
$3.89Published rateAssociated Specialists In Medicine, PC
Associated Specialists In Medicine PC
$2.63Published rate
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See a sample payer proposalCPT 95004 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95004 code is part of the Medicine Services and Procedures services used for Allergy and Clinical Immunology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95004 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95004-CPT | Low | Allergy Skin Tests, Test For Allergies To Pollen Animal Dander Drugs Or Other Substances. The Test Is Performed By Placing A Small Amount Of The Suspected Allergen Under The Skin And Monitoring To See If A Reaction Occurs. |
| 95017-CPT | Low | 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 Number Of Tests(Reinstated) Sensitivity Skin Tests 11-15 (Intradermal) (Old Description Deleted 03/31/2003) |
| 95018-CPT | Low | Allergy Testing Any Combination Of Percutaneous (Scratch Puncture Prick) And Intracutaneous (Intradermal) Sequential And Incremental With Drugs Or Biologicals Immediate Type Reaction Including Test Interpretation And Report Specify Number Of Tests (Reinstated) Sensitivity Skin Tests 15+ (Intradermal) (Old Description Deleted 03/31/2003) |
| 95024-CPT | Low | Allergy Skin Tests, Test For Allergies To Pollen Animal Dander Drugs Or Other Substances. The Test Is Performed By Placing A Small Amount Of The Suspected Allergen Under The Skin And Monitoring To See If A Reaction Occurs. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95004. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95004 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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