Billing code 95076: Ingestion challengeMedicare rate & RVUs
Reports supervised oral challenge testing, such as a food or medication challenge, for the initial testing interval used to assess a suspected reaction.
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 rate · 95076
Ingestion challenge
Swap in your local Medicare rate.
- Work RVUs
- 1.5
- Total RVUs
- 3.69
- Global days
- XXX
National rate · 2026
$123.25
Office setting, before claim adjustments.
See every locality for 95076 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
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 payment localities
$112.25 to $159.28
109 of 109 payment localities
95076 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $152.02 | 1 |
| AL | $113.49 | 1 |
| AR | $112.25 | 1 |
| AZ | $120.76 | 1 |
| CA | $130.00–$159.28 | 29 |
| CO | $127.96 | 1 |
| CT | $130.15 | 1 |
| DC | $138.84 | 1 |
| DE | $122.44 | 1 |
| FL | $121.13–$129.23 | 3 |
| GA | $115.95–$124.94 | 2 |
| GU | $132.15 | 1 |
| HI | $132.15 | 1 |
| IA | $115.99 | 1 |
| ID | $116.50 | 1 |
| IL | $118.19–$127.07 | 4 |
| IN | $117.03 | 1 |
| KS | $115.43 | 1 |
| KY | $115.18 | 1 |
| LA | $114.98–$119.32 | 2 |
| MA | $127.41–$138.88 | 2 |
| MD | $124.44–$138.84 | 3 |
| ME | $116.80–$121.87 | 2 |
| MI | $117.32–$122.13 | 2 |
| MN | $123.90 | 1 |
| MO | $113.38–$119.84 | 3 |
| MS | $112.84 | 1 |
| MT | $123.25 | 1 |
| NC | $117.76 | 1 |
| ND | $122.06 | 1 |
| NE | $116.52 | 1 |
| NH | $125.92 | 1 |
| NJ | $131.99–$137.93 | 2 |
| NM | $117.75 | 1 |
| NV | $122.99 | 1 |
| NY | $119.10–$141.62 | 5 |
| OH | $117.08 | 1 |
| OK | $115.19 | 1 |
| OR | $122.37–$131.43 | 2 |
| PA | $117.31–$127.45 | 2 |
| PR | $124.00 | 1 |
| RI | $126.33 | 1 |
| SC | $117.54 | 1 |
| SD | $121.92 | 1 |
| TN | $115.85 | 1 |
| TX | $116.70–$127.25 | 8 |
| UT | $118.78 | 1 |
| VA | $121.45–$138.84 | 2 |
| VI | $124.00 | 1 |
| VT | $121.55 | 1 |
| WA | $127.19–$141.54 | 2 |
| WI | $118.87 | 1 |
| WV | $114.79 | 1 |
| WY | $122.73 | 1 |
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
Swap in your local Medicare rate.
Work 1.50Practice expense 2.13Malpractice 0.06
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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).
Non-facility (office) rate · national
$123.25
The facility rate would be $62.46 (+$60.79). In a facility, the facility bills its own costs separately.
95076 compared with similar codes
Compare codes
95076 vs 95079 vs 95070 vs 95018 vs 95004: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 95079Ingestion challenge
- 95076 reports the initial ingestion challenge interval. Use 95079 for each additional 60 minutes of testing when the challenge continues.
- 95070Bronchial challenge
- 95070 is for bronchial challenge by inhalation. Choose 95076 when the test substance is administered orally.
- 95018Drug allergy testing
- 95018 reports percutaneous and intradermal drug or biological testing; 95076 reports a monitored challenge by ingestion.
- 95004Allergy skin prick test
- 95004 is percutaneous allergen testing, not an oral challenge assessing whether a patient tolerates an ingested substance.
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
Fee sheets
Put 95076 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →