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

In Puerto Rico, Medicare pays $124.00 for 95076 in the office and $62.54 when it’s performed in a hospital or facility.

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.

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 Puerto Rico 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. Puerto Rico pays $124.00. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

95076 rates by state

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

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.

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.

Codes related to 95076

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

How 95076 has changed in Puerto Rico

Price 95076 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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