$6.89
Use 95004 when an allergenic extract is introduced by scratch, prick, or puncture and read for an immediate reaction. Use 95024 for intradermal extract testing read for an immediate reaction.
On this page
CMS RVU26D · Effective 2026-10-01
95004 Allergy skin prick test Medicare reimbursement rates in Tennessee
Percutaneous scratch, prick, or puncture testing with allergenic extracts evaluates immediate allergic reactions and is reported for each individual test performed. Compare 95004 office and facility rates across CMS payment localities in Tennessee.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 95004 in Tennessee?
Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$3.25
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Allergy testing
About 95004: Percutaneous allergy skin testing, immediate reaction
Percutaneous scratch, prick, or puncture testing with allergenic extracts evaluates immediate allergic reactions and is reported for each individual test performed.
Allergists, otolaryngologists, and some primary care clinicians perform percutaneous testing to evaluate suspected immediate allergies, including allergic rhinitis, asthma triggers, and food allergy. Small amounts of allergenic extract are introduced through a scratch, prick, or puncture on the forearm or back. The resulting wheal and flare are read shortly afterward. Typical extracts include pollens, dust mites, animal dander, molds, and foods. Clinical staff may apply and read the tests under physician supervision; interpretation and a report are included in the service.
Report one unit for each individual percutaneous test performed, rather than one unit for the panel. Document the extracts, controls, test sites, reactions, read time, and interpretation to support the reported count. When clinically indicated, separately performed intradermal immediate-reaction tests with allergenic extracts are reported with 95024 and their own test count. Do not bill separately for the interpretation of 95004. A significant, separately identifiable office evaluation on the same date may be reported with an appropriate E/M code and modifier 25 on the E/M service.
Where the value comes from
- Work RVU0.01 · 9%
- Practice expense (office) RVU0.09 · 82%
- Malpractice RVU0.01 · 9%
8.6M
Medicare services in 2024 · #25 by national volume
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.
95004 compared with similar codes
Office rates for Tennessee, from the same CMS release.
$7.38
Use 95017 for stinging insect venom tests performed percutaneously, intradermally, or by both methods. Do not also report 95004 for the same venom tests.
$4.43
Patch testing applies allergens to the skin to evaluate delayed contact reactions, generally read over days. Tests under 95004 evaluate immediate reactions after a scratch, prick, or puncture.
$17.61
Use 95018 for testing with drugs or biologicals, whether percutaneous, intradermal, or combined. Use 95004 for percutaneous immediate-reaction tests with allergenic extracts, such as pollen or food extracts.
Compare 95004 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Tennessee →
Office / nonfacility
$3.25
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 95004 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
12,457
- Code
- 95004
- Physician work
- 0.01
- Practice expense
- 0.09
- Malpractice
- 0.01
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.01 | × 1.000 | 0.0100 |
| Practice expense | 0.09 | × 0.909 | 0.0818 |
| Malpractice | 0.01 | × 0.537 | 0.0054 |
| Total RVUs | 0.0972 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Tennessee$3.25
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.01 | 1 |
| Practice expense | 0.09 | 0.909 |
| Malpractice | 0.01 | 0.537 |
(0.01 × 1 + 0.09 × 0.909 + 0.01 × 0.537) × $33.4009 = $3.25
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
95004 billing questions
How many units of 95004 are reported for a skin test panel?
Report one unit per individual percutaneous test performed, not one unit for the panel. The record should identify the tested extracts so the count can be verified.
Can 95004 and 95024 be billed on the same day?
Yes, when both percutaneous and clinically indicated intradermal immediate-reaction testing with allergenic extracts are performed. Report each code with its own test count and document which extracts received each method.
Should 95004 be used for insect venom or drug allergy testing?
Use 95017 for stinging insect venom testing and 95018 for drug or biological testing. Those codes cover percutaneous testing, intradermal testing, or a combination, as performed.
Is the physician interpretation billed separately?
No. Interpretation and reporting of the skin test results are included in 95004. A significant, separately identifiable E/M service may be reported with modifier 25 on the E/M code.
What documentation supports 95004?
Record the extracts and controls, percutaneous method, test sites, wheal and flare measurements or grading, read time, and interpretation. The documented tests should support the number of units billed.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,45494799,,Unlisted pulmonary svc/px,C,,0.00,0.00,,0.00,NA,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,45594799,26,Unlisted pulmonary svc/px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,45694799,TC,Unlisted pulmonary svc/px,C,,0.00,0.00,,0.00,NA,0.00,0.00,0.00,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,45795004,,Perq tests w/alrgnc xtrcs,A,,0.01,0.09,,0.09,NA,0.01,0.11,0.11,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
12,45895012,,Nitric oxide exp gas deter,A,,0.00,0.58,,0.58,NA,0.01,0.59,0.59,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,45995017,,All tstg perq&iq w/venoms,A,,0.07,0.16,,0.01,,0.01,0.24,0.09,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,46095018,,All tstg perq&iq drugs/biol,A,,0.14,0.42,,0.03,,0.01,0.57,0.18,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780