Billing code 95004: Allergy skin prick testMedicare rate & RVUs in Virginia
Percutaneous scratch, prick, or puncture testing with allergenic extracts evaluates immediate allergic reactions and is reported for each individual test performed.
Medicare pays $3.52–$4.26 for 95004 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. Which amount applies depends on the service address.
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 9 sections
What 95004 covers
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.
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 95004 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $4.26 | Unavailable |
| Virginia | $3.52 | Unavailable |
How the 95004 rate is calculated
Each of 95004’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 · 95004
RVUs × geographic indexes × conversion factor
Work0.01
0.01 RVUs× 1.000 GPCI
Practice expense0.09
0.09 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.1100
Conversion factor
$33.4009
Medicare rate
$3.67
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 95004
95004 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 · 95004
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$3.67
Higher because the practice carries its own overhead.
95004 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 95024Intradermal allergy test
- 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.
- 95017Venom testing
- Use 95017 for stinging insect venom tests performed percutaneously, intradermally, or by both methods. Do not also report 95004 for the same venom tests.
- 95044Patch testing
- 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.
- 95018Drug allergy testing
- 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.
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 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
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