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CPT code 95076: Ingestion challenge, initial 120 minutes2026 Medicare rate & RVUs in Santa Clara County, CA

Reports supervised oral challenge testing, such as a food or medication challenge, for the initial testing interval used to assess a suspected reaction.

CMS RVU26DEffective Oct 1, 2026One payment locality12.9K Medicare services in 2024

In Santa Clara County, CA, Medicare pays $159.00 for 95076 in the office and $71.34 when it’s performed in a hospital or facility.

$159.00Office (non-facility)
$71.34Hospital or facility
+29.0%vs the national office rate ($123.25)

Check a contract rate as a % of Medicare · 95076 nationwide

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

We’ll open 95076 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 95076 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Santa Clara County, CA compares for 95076

Across 109 of 109 payment localities, the office rate for 95076 runs from $112.25 in Arkansas to $159.28 in San Benito County, CA. Santa Clara County, CA pays $159.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

95076 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$159.00
  2. Bakersfield, CA · California$130.25−$28.75
  3. Chico, CA · California$130.00−$29.00
  4. El Centro, CA · California$130.01−$28.99
  5. Fresno, CA · California$130.00−$29.00
  6. Hanford, CA · California$130.00−$29.00
  7. Los Angeles, CA · California$137.65−$21.35

Other areas in California first, then benchmark localities. Bars start at $0.

Every other payment area

95076 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$130.00$63.38
Merced, CACalifornia$130.00$63.38
Modesto, CACalifornia$130.00$63.38
Napa, CACalifornia$148.04$67.92
Oxnard, CACalifornia$136.84$64.99
Redding, CACalifornia$130.00$63.38
Rest of CaliforniaCalifornia$130.00$63.38
Riverside, CACalifornia$130.69$64.06

95076 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$112.25

$152.02

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
95076 office rate range by state
State / territoryOffice rate rangeLocalities
AK$152.021
AL$113.491
AR$112.251
AZ$120.761
CA$130.00–$159.2829
CO$127.961
CT$130.151
DC$138.841
DE$122.441
FL$121.13–$129.233
GA$115.95–$124.942
GU$132.151
HI$132.151
IA$115.991
ID$116.501
IL$118.19–$127.074
IN$117.031
KS$115.431
KY$115.181
LA$114.98–$119.322
MA$127.41–$138.882
MD$124.44–$138.843
ME$116.80–$121.872
MI$117.32–$122.132
MN$123.901
MO$113.38–$119.843
MS$112.841
MT$123.251
NC$117.761
ND$122.061
NE$116.521
NH$125.921
NJ$131.99–$137.932
NM$117.751
NV$122.991
NY$119.10–$141.625
OH$117.081
OK$115.191
OR$122.37–$131.432
PA$117.31–$127.452
PR$124.001
RI$126.331
SC$117.541
SD$121.921
TN$115.851
TX$116.70–$127.258
UT$118.781
VA$121.45–$138.842
VI$124.001
VT$121.551
WA$127.19–$141.542
WI$118.871
WV$114.791
WY$122.731

See 95076 in every payment locality

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.

How the rate is built · 95076

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.50

1.50 RVUs× 1.000 GPCI

Practice expense2.13

2.13 RVUs× 1.000 GPCI

Malpractice0.06

0.06 RVUs× 1.000 GPCI

Adjusted RVUs

3.6900

Conversion factor

$33.4009

Medicare rate

$123.25

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Santa Clara County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,470

Code
95076
Physician work
1.50
Practice expense
2.13
Malpractice
0.06

GPCI2026.csv

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 95076 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work1.50× 1.1101.6650
Practice expense2.13× 1.4423.0715
Malpractice0.06× 0.3970.0238
Total RVUs4.7603
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$159.00

Office: (1.5 × 1.11 + 2.13 × 1.442 + 0.06 × 0.397) × $33.4009 = $159.00

Facility: (1.5 × 1.11 + 0.31 × 1.442 + 0.06 × 0.397) × $33.4009 = $71.34

Open 95076 in the RVU calculator

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.

Place of service · 95076

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$123.25

Non-facility (office)
$123.25
Facility
$62.46

Higher because the practice carries its own overhead.

Codes related to 95076

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

Codes related to 95076
CodeHow it relatesOffice range, Santa Clara County, CA
Add-on codes
95079Ingestion challenge, each additional 60 minutesAdd-on code for each additional 60 minutes of ingestion challenge testing.$105.29
Used instead
95070Bronchial challenge, technical testingUsed for bronchial inhalation challenge testing rather than an orally administered challenge.$56.27
95018Drug allergy testing, percutaneous and intracutaneous testsDrug allergy skin testing uses percutaneous or intradermal testing, not an oral ingestion challenge.$25.55
95004Allergy skin prick test, percutaneous, immediate reaction, per testPercutaneous allergen testing evaluates skin reactivity rather than tolerance during oral ingestion.$4.84

How 95076 has changed in Santa Clara County, CA

95076 · Office / nonfacility

$159.00

Effective 2026-10-01

The base rate is $3.30 higher than on 2025-10-01, moving from $155.70 to $159.00 (2.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $155.70changed to$159.00

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.19 changed to 2.13
    • Malpractice RVU 0.05 changed to 0.06
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $157.99changed to$155.70

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.14 changed to 2.19
    • Malpractice RVU 0.06 changed to 0.05

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $155.41changed to$157.99

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $154.06changed to$155.41

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.04 changed to 2.14
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $150.74changed to$154.06

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.94 changed to 2.04
    • Malpractice RVU 0.07 changed to 0.06
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $149.29changed to$150.74

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.89 changed to 1.94
    • Malpractice RVU 0.05 changed to 0.07

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $149.25changed to$149.29

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.81 changed to 1.89
    • Malpractice RVU 0.06 changed to 0.05
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $150.63changed to$149.25

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.87 changed to 1.81
    • Work GPCI 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $148.52changed to$150.63

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.83 changed to 1.87

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $142.72changed to$148.52

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.72 changed to 1.83
    • Work GPCI 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $142.76changed to$142.72

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.73 changed to 1.72
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $142.64changed to$142.76

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.72 changed to 1.73
    • Malpractice RVU 0.05 changed to 0.06

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $141.93changed to$142.64

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $142.20changed to$141.93

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.73 changed to 1.72
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $141.82changed to$142.20

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.89 changed to 1.73
    • Work GPCI 1.077 changed to 1.083
    • Practice expense GPCI 1.337 changed to 1.342
    • Malpractice GPCI 0.516 changed to 0.466

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$141.82

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$159.00$71.34RVU26D
2026-07-01$159.00$71.34RVU26C
2026-04-01$159.00$71.34RVU26B
2026-01-01$159.00$71.34RVU26A
2025-10-01$155.70$83.76RVU25D
2025-07-01$155.70$83.76RVU25C
2025-04-01$155.70$83.76RVU25B
2025-01-01$155.70$83.76RVU25A
2024-10-01$157.99$85.38RVU24D
2024-07-01$157.99$85.38RVU24C
2024-04-01$157.99$85.38RVU24B
2024-03-09$157.99$85.38RVU24AR
2024-01-01$155.41$83.99RVU24A
2023-10-01$154.06$85.79RVU23D
2023-07-01$154.06$85.79RVU23C
2023-04-01$154.06$85.79RVU23B
2023-01-01$154.06$85.79RVU23A
2022-10-01$150.74$86.13RVU22D
2022-07-01$150.74$86.13RVU22C
2022-04-01$150.74$86.13RVU22B
2022-01-01$150.74$86.13RVU22A
2021-10-01$149.29$86.56RVU21D
2021-07-01$149.29$86.56RVU21C
2021-04-01$149.29$86.56RVU21B
2021-01-01$149.29$86.56RVU21A
2020-10-01$149.25$87.98RVU20D
2020-07-01$149.25$87.98RVU20C
2020-04-01$149.25$87.98RVU20B
2020-01-01$149.25$87.98RVU20A
2019-10-01$150.63$88.17RVU19D
2019-07-01$150.63$88.17RVU19C
2019-04-01$150.63$88.17RVU19B
2019-01-01$150.63$88.17RVU19A
2018-10-01$148.52$86.13RVU18D
2018-07-01$148.52$86.13RVU18C
2018-04-01$148.52$86.13RVU18B
2018-01-01$148.52$86.13RVU18AR1
2017-10-01$142.72$84.54RVU17D
2017-07-01$142.72$84.54RVU17C
2017-04-01$142.72$84.54RVU17B
2017-01-01$142.72$84.54RVU17A
2016-10-01$142.76$84.41RVU16D
2016-07-01$142.76$84.41RVU16C
2016-04-01$142.76$84.41RVU16B
2016-01-01$142.76$84.41RVU16A
2015-10-01$142.64$84.08RVU15D
2015-07-01$142.64$84.08RVU15C
2015-04-01$141.93$83.66RVU15B
2015-01-01$141.93$83.66RVU15A
2014-10-01$142.20$84.51RVU14D
2014-07-01$142.20$84.51RVU14C
2014-04-01$142.20$84.51RVU14B
2014-01-01$142.20$84.51RVU14A
2013-10-01$141.82$81.32RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 95076 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

95076 billing questions

When is 95076 appropriate instead of allergy skin testing?

Use 95076 when the clinician evaluates tolerance by administering the suspected food or medication orally in a monitored challenge. Skin testing, such as 95004 or 95018, records a different testing method.

Can 95079 be reported with 95076?

Yes. 95076 represents the initial testing interval, and 95079 is the add-on code for each additional 60 minutes of ingestion challenge testing.

What should the record support?

Document the substance administered, incremental challenge steps, elapsed testing time, monitoring findings, and any reaction or treatment. The record should show that an oral challenge was performed, rather than only a discussion or history review.

Is a food challenge the only service reported with 95076?

No. The code can describe an oral challenge involving a medication as well as a food. The documentation should make clear what substance was ingested and how the challenge was conducted.

Does 95076 cover an inhaled allergen challenge?

No. 95076 is for an ingested challenge; 95070 describes bronchial inhalation challenge testing.

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

Show the CMS file lines behind this rate
RVUs for 95076PPRRVU2026_Oct_nonQPP.csv, line 12,470 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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