CPT 95028 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Allergy and Clinical Immunology Procedures |
| Common Place of Service | • 11 - Office • 20 - Urgent Care Facility |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 95028 |
National average reimbursement for CPT 95028 by major payers:
$16.28
$22.92
$15.09
$18.22
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 95028 | ||||||
United | 95028 | $24.52 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $31.44 | 1508192048 - DIANA SIECIECHOWICZ | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95028 | $16.56 | 1932272952 - MOHAMMED HOMSI | 452353153 - (IL) HOMSI PEDIATRIC NEUROLOGY INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 95028 | $12.78 | 1144777541 - LEANNE MCNABNEY | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Orthopedic Physical Therapist (2251X0800X) |
United | 95028 | $16.86 | 1144476136 - STEVE PASCHOS | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $21.27 | 1629177662 - BARBARA TWARDOWSKI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95028 | $11.31 | 1982629051 - THOMAS HERRMANN | 363637465 - (IL) HOOPESTON COMMUNITY MEMORIAL HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $16.93 | 1568533701 - REGINALD GIVENS | 362235167 - ROSECRANCE INC | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $21.69 | 1407807746 - SYED KHAN | 320552496 | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $16.56 | 1932216702 - ANAND KUMAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $15.11 | 1881012235 - LAUREN PREST | 910843135 | UT | Psychiatry Physician (2084P0800X) |
United | 95028 | $13.97 | 1871231233 - CONNOR MALDONADO | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physician Assistant (363A00000X) |
United | 95028 | $16.89 | 1275564197 - PAUL BERKOWITZ | 363330928 - (IL) PRESENCE HEALTHCARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 95028 | $16.86 | 1902917818 - FAZAL AHMED | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 95028 | $20.60 | 1871505230 - MICHAEL NAYLOR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 95028 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95028 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 95028 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 | Percutaneous Tests (Scratch Puncture Prick) Withallergenic Extracts Immediate Type Reaction Including Test Interpretation And Report Specify Number Of Tests (Revised 01/01/13) |
| 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) |
| 95028-CPT | Low | Intracutaneous (Intradermal) Tests With Allergenic Extracts, Delayed Type Reaction, Including Reading, Specify Number Of Tests |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95028. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95028 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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