CPT code 95076: Ingestion challenge, initial 120 minutes2026 Medicare rate & RVUs

Medicare pays $123.25 for 95076 nationally in the office and $62.46 in a hospital or facility. Local office rates run $112.25–$159.28.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 95076 covers

An ingestion challenge involves giving a patient measured, sequential amounts of a suspected food or medication by mouth while observing for an allergic response. Allergists and other clinicians experienced in allergy evaluation commonly perform these challenges in an office or facility equipped to monitor the patient and respond to reactions. Examples include assessing whether a patient can tolerate a food or an oral medication after a history of possible allergy.

Report 95076 for the initial testing interval; when testing continues beyond that interval, 95079 is the add-on code for additional testing time. Documentation should identify the ingested substance, the incremental doses or challenge steps, the testing time, observations, and any symptoms or intervention. CMS physician fee schedule values for this service include physician work, practice expense, and malpractice components, with practice expense values differing between office and facility settings.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 95076 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

95076 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 95076 rate is calculated

Each of 95076’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 95076

95076 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

95076 compared with similar codes

How to choose

95079Ingestion challengeEach additional 60 minutes

95076 reports the initial ingestion challenge interval. Use 95079 for each additional 60 minutes of testing when the challenge continues.

95070Bronchial challengeTechnical testing

95070 is for bronchial challenge by inhalation. Choose 95076 when the test substance is administered orally.

95018Drug allergy testingPercutaneous and intracutaneous tests

95018 reports percutaneous and intradermal drug or biological testing; 95076 reports a monitored challenge by ingestion.

95004Allergy skin prick testPercutaneous, immediate reaction, per test

95004 is percutaneous allergen testing, not an oral challenge assessing whether a patient tolerates an ingested substance.

Codes related to 95076

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates