CPT 95004: allergy skin prick tests, billed per test
95004 reports one percutaneous allergy test, meaning one allergen extract applied by prick, puncture or scratch, with the physician's reading and report. It is a per-test code: a panel of 40 allergens is 40 units on one claim line, not one visit.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 95004 is counted by the number of separate tests, never by visits or panels, and positive and negative controls are not counted. Medicare's practitioner edit limit is 80 units a day, and a same-day visit needs modifier 25 plus a separate reason.
What does CPT 95004 report?
95004 is the CPT code for a single percutaneous allergy test with an allergenic extract. Chapter 12, section 200 A, of the Medicare Claims Processing Manual describes the family as scratch, puncture or prick tests, and says the fee schedule amount is set for a single test, so the number of tests must be shown on the claim.
The CMS fee schedule file shortens the descriptor to "Perq tests w/alrgnc xtrcs". The intracutaneous (intradermal) sibling is 95024, and the stepped dilution tests are 95017, 95018 and 95027, which NCCI calls "sequential and incremental" tests.
| Item in RVU26D | 95004 |
|---|---|
| Payment status | A (active, paid separately) |
| Work RVU | 0.01 |
| Total RVU, non-facility | 0.11 |
| Global period | XXX (global concept does not apply) |
| Multiple procedure indicator | 0 |
| Practitioner MUE, effective 10-01-2026 | 80 (indicator 3) |
How many allergy skin tests can I bill?
Bill one unit for each separate test, up to the MUE of 80 per date of service. Chapter 12, section 200 A, gives the rule in one line: 25 prick tests with extract are billed as code 95004 with 25 units, and the MAC multiplies the single-test payment by the units.
Positive and negative controls are not counted. Chapter XI of the 2026 NCCI Policy Manual says CMS payment policy does not allow control tests in the number reported, and its example is six allergens plus a positive and a negative control, which is 6 tests.
A patient is pricked for 40 allergens, plus a histamine control and a saline control. The 95004 line carries 40 units. The two controls add no units and no extra lines.
The MUE adjudication indicator of 3 means the limit applies per date of service, so 81 or more units on one day can deny even when each unit is documented. The MUE file lists its basis as a CMS workgroup judgment.
Can 95004 be billed with intradermal or sequential tests?
Yes, when the tests are for different allergens or different dilutions of the same allergen. NCCI Chapter XI, section K, says the single-test codes (95004 and 95024) and the sequential and incremental codes (95017, 95018, 95027) may all be reported on one date, and the unit is the number of separate tests.
The same dilution of the same allergen cannot be billed twice. If a single prick test is positive and the physician moves to 3 more dilutions of that antigen, NCCI allows 1 unit of the single test code and 3 units of the sequential code.
Do not add a second test code to cover allergen potency checks before a shot. NCCI says confirming the potency of a vial for immunotherapy is part of the immunotherapy, so testing codes are not reported for it.
Can I bill a visit on the same day as skin testing?
Only when the visit is significant, separately identifiable and not part of the testing work. NCCI Chapter XI, section K, item 3, says an E/M service reported with allergy testing or immunotherapy needs modifier 25.
NCCI Chapter I adds that a visit on the same day as an XXX procedure cannot include work inherent in the procedure, supervision of staff doing it, or time spent interpreting the results. Allergy testing is one of its named XXX examples, so a note that only records ordering and reading the tests does not support a separate visit.
How does 95004 appear on the claim?
On the CMS-1500, Item 24D carries 95004, Item 24G carries the number of tests, and Item 24E points to the diagnosis. Chapter 26 names allergy testing among the services where the actual quantity must be shown, and tells billers to enter 1 only when a single service was performed.
Allergy testing is usually done in the office, place of service 11. The visit line, if any, carries modifier 25 and the test line carries none. See allergy and immunology billing for how testing, extract and shots fit together on one patient.
How do skin test units appear on the claim?
Allergy skin tests are billed by the number of tests. Item 24D carries 95004 and Item 24G carries the number of allergens tested, since Chapter 26 says to enter the actual number when multiple services are provided. Item 24E points to the allergy diagnosis.
RVU26D gives 95004 status A and the MUE table allows 80 per date with indicator 3, a CMS workgroup rationale. The chart should list each allergen and result.
Example: A patient with hay fever has 40 allergens tested on 10/17. The line is 95004, pointer A (J30.1), 40 units, $11.00 each. If 40 units are billed but the chart lists 30 allergens, the extra 10 are unsupported.
Why is 95004 denied?
| CARC | What X12 says | What usually causes it |
|---|---|---|
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services | More than the MUE of 80 units, or repeat panels inside a payer's frequency window |
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated | Potency testing billed with immunotherapy, or testing billed with rapid desensitization |
| 16 | Claim/service lacks information or has submission/billing error(s) | Units left at 1, or a test count that does not match the note |
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer | No documented symptoms or exposure history for the allergens tested |
If these denials keep coming back, our denial management team can work them. Related pages: CO-151, CO-97 and the medically unlikely edits rule.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner table, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, Chapter XI: Medicine, Evaluation and Management Services · CMS
- 2026 NCCI Medicare Policy Manual, Chapter I: General Correct Coding Policies · CMS
- Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does CPT 95004 mean?
It reports one percutaneous allergy test, where an allergenic extract is applied by prick, puncture or scratch and the physician reads and reports the result. It is a per-test code, so the number of tests, not the number of visits, sets the units.
02How many allergy skin tests can I bill?
One unit per separate test, up to the Medicare MUE of 80 units per date of service in the October 2026 practitioner table. Controls do not count. CMS's own example is 25 prick tests billed as 95004 with 25 units.
03Do I bill the positive and negative controls?
No. NCCI Chapter XI says CMS payment policy does not allow control tests in the count. Its example is six allergens plus a positive and a negative control, which is 6 tests billed, not 8. Count the allergens only, and enter that number in the units box of the 95004 line.
04Can 95004 and 95024 be billed on the same day?
Yes, if the tests are for different allergens or different dilutions. NCCI Chapter XI allows the single prick and intradermal codes and the sequential codes together on one date, counting the number of separate tests. The same dilution cannot be billed twice.
05Do I need modifier 25 for a visit with skin testing?
Yes, when a separately identifiable visit is billed. NCCI says the E/M must be significant and cannot include work inherent in the testing or time spent reading it. Modifier 25 goes on the visit line, not on the test line itself, and the note should show what the visit covered beyond ordering and reading the tests.
Testing claims paid short?
We check the test count, the controls and the modifier 25 line before the claim goes out.