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See a sample rate comparisonCPT 95056 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.
Photo Tests
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Allergy and Clinical Immunology Procedures |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $51.77 national non-facility rate (2026) · View Medicare rates for 95056 |
| Medicaid Fee Schedule | $41.505 median of the 8 states in the free preview · View Medicaid rates for 95056 |
National average reimbursement for CPT 95056 by major payers:
$58.81
$50.40
$56.55
$64.50
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CPT 95056
5 of 25 sample ratesHigher to lower in this preview
Lauren Schumacher
$342.54Published rateLaura Vernon
Pediatric Faculty Foundation In
$82.44Published rateWalter Whang
Edward Health Ventures
$70.11Published rateAshley Boyle
Town Center Orthopaedic Associates, P.C.
$50.82Published rateMelissa Wagner-Schuman
$22.30Published rate
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See a sample payer proposalCPT 95056 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95056 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 95056 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. |
| 95044-CPT | Low | Patch Or Application Test(S) (, Patch Or Application Test(S) (Specify Number Of Tests)Patch Or Application Test(S) (Specify Number Of Tests) |
| 95052-CPT | Low | Photo Patch Test(S) (Specify N, Photo Patch Test(S) (Specify Number Of Tests)Photopatch Test(S) (Specify Number Of Tests) |
| 95056-CPT | Low | Photo Tests |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95056 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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