Billing code 95052: Photopatch testingMedicare rate & RVUs in Virginia
Photopatch testing evaluates suspected light-dependent contact allergy by comparing skin reactions to applied substances with and without light exposure.
Medicare pays $5.82–$7.06 for 95052 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 95052 covers
Photopatch testing evaluates suspected photoallergic contact dermatitis, such as a reaction linked to a topical medication, sunscreen, or fragrance after sun exposure. The clinician applies suspected substances to the skin under patches, then exposes one test area to light while keeping a comparison area shielded. Subsequent skin responses are interpreted to determine whether the reaction depends on light. Dermatologists and allergists commonly perform this testing in an office setting.
Report 95052 for the photopatch procedure, which includes application and interpretation. Documentation should identify the clinical concern, substances tested, test locations, exposure and comparison conditions, and observed reactions. CMS assigns 0 work RVUs, 0.17 practice-expense RVUs, and 0.01 malpractice RVUs. This is an incident-to service and is billed only when performed under physician supervision.
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 95052 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $7.06 | Unavailable |
| Virginia | $5.82 | Unavailable |
How the 95052 rate is calculated
Each of 95052’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 · 95052
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.00Practice expense 0.17Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 95052
The CMS indicators that decide how 95052 is paid alongside other services.
CMS payment indicators · 95052
Photopatch testing
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
95052 compared with similar codes
Compare codes
95052 vs 95044 vs 95056: national Medicare rates
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How to choose
- 95044Patch testing
- Choose 95044 for conventional patch or application testing. Choose 95052 when the evaluation compares reactions to applied substances with and without light exposure.
- 95056Phototesting
- 95056 evaluates skin response to light itself. 95052 evaluates whether light changes the skin's reaction to an applied substance.
95052 billing questions
How does 95052 differ from 95044?
95052 evaluates whether light contributes to a skin reaction to an applied substance. 95044 is used for conventional patch or application testing without the photopatch comparison.
How does photopatch testing differ from 95056?
Photopatch testing assesses reactions to applied substances with and without light exposure. 95056 evaluates the skin's response to light itself, without testing an applied contact allergen.
Does 95052 include application and interpretation?
Yes. The photopatch service includes applying the test materials and interpreting the reactions; document the testing and findings in the record.
Can staff perform the testing for a physician claim?
CMS identifies 95052 as an incident-to service, so it is billed only when performed under physician supervision.
What documentation supports reporting 95052?
Document the suspected light-dependent contact reaction, the substances and sites tested, which area received light exposure, the comparison conditions, and the interpreted skin findings.
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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