When should I use 95004?

Skin prick allergy testing. Billed per-test (per antigen).

What documentation does 95004 require?

- List of antigens tested. - Reactions (wheal/flare measurements). - Interpretation with positive/negative panel.

What are common 95004 billing pitfalls?

- Billing as one unit when 40 antigens were tested — must report number of tests in units. - Patient on antihistamines invalidates the test.

How much does 95004 pay in 2026?

2026 work RVU for 95004 is 0.01. National Medicare non-facility allowable is approximately $4.68 at the 2026 conversion factor. Adjust for locality GPCI and your payer's contracted conversion factor for actual payment.

Allergy · CMS status A

95004

Percutaneous allergy test (per test)

Percutaneous tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests.

Allergy

Model in calculator →Audit a note

Work RVU

0.01

2026 Medicare pays

$4.68

National GPCI · non-facility · CF $33.4009

RVU anatomyWork 0.01 + Practice 0.13 + Malpractice 0.00 = 0.14 total

Work (your effort)Practice expenseMalpractice

When to use it

Skin prick allergy testing.

Full guidance

Billed per-test (per antigen).

Documentation checklist

✓List of antigens tested.
✓Reactions (wheal/flare measurements).
✓Interpretation with positive/negative panel.

Common pitfalls

!Billing as one unit when 40 antigens were tested — must report number of tests in units.
!Patient on antihistamines invalidates the test.

Common ICD-10 pairings

Z91.030J30.1

Pairs well with

95024

0.01 wRVU

Intradermal allergy test (per test)

Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.