CPT code 95004: Allergy skin prick test2026 Medicare rate & RVUs in Washington

Medicare pays $3.76–$4.31 for 95004 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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.

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 Washington

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.

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.

95004 compared with similar codes

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.

Codes related to 95004

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

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