Chapter 2: Allergy Testing

CPT classifies an allergy as a general or localized reaction to an agent such as penicillin or cat dander inflicted
by the immune system. Tests can be performed to identify the allergy. You need to differentiate single allergy tests
from multiple allergy tests. A clinical suspicion of allergy, based on thorough history, examination, and appropriate
laboratory evaluation, must be conducted prior to allergy testing. Patient education and immunotherapy should follow.
Codes 95004, 95024, 95027, and 95028 require direct supervision. Coding experts offer four tips for distinguishing
among codes in the 95004-95028 family:

95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction; including
test interpretation and report, specify number of tests
95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test
interpretation and report, specify number of tests
95027 Intracutaneous (intradermal) texts, sequential and incremental, with allergenic extracts for airborne
allergens, immediate type reaction, including test interpretation and report, specify number of tests
95028 Intracutaneous (intradermal) tests, with allergenic extracts, delayed reaction type, including reading,
specify number of tests.

Know the Test's Type

You should report allergy testing based on whether your allergist or nurse administers a percutaneous or an
intracutaneous test. When your allergist administers the test through the skin, you should report a percutaneous skin
test. These tests include scratch, puncture and skin tests, which CPT defines as 95004.
Example: A physician performs 20 percutaneous tests (scratch, puncture, or prick) with allergenic extract. You code
95004 and specify 20 in the "units" field of form CMS-1500.
If your pediatrician instead injects a substance into the patient's skin, you should report an intracutaneous or
intradermal test. Possible tests include 95024, 95027, and 95028.
Watch out: When the physician orders in vitro tests, such as RAST (radio allergosorbent tests), FAST (fluorescent
allergosorbent tests) or ELISA (enzyme-linked immunosorbent assay), you should use 86003 (Allergen specific IgE;
quantitative or semiquantitative, each allergen). To report the lab code, your office must analyze the specimen, not
merely send it to a lab. Most carriers will not pay for these tests except under certain conditions. For instance, insurers
may cover the tests when the patient is a child younger than 4 years of age.
Check the Substances Tested
Consider whether your pediatrician tested the patient for environmental and food allergens rather than biological or
insect substances. Codes 95004, 95024, and 95028 all describe testing allergenic extracts, such as weed, grass, mite,
animal dander, and food, according to CPT Assistant, summer 1991.
Watch out: Use 95027 for airborne allergens only, which includes all the environmental allergens, but not food
allergies.
Example: Your pediatrician applies dust, dog dander, and molds to skin scratches. In this case, you should report

CPT 2014 American Medical Association. All rights reserved.

95004 for percutaneous allergenic extract tests, which all payers cover.
Verify the Reaction Time
Check whether staff administers straight or sequential intradermal testing. In 95027, the physician injects small
amounts of suspected allergens intradermally over time. These tests usually take one to three hours. During this
interval, the physician observes the injected area for 15-20 minutes. The physician gradually administers more
concentrated amounts of the antigen to determine the patient's immunotherapy starting point.
Most allergy tests involve immediate same-day reactions. When your physician evaluates allergenic extract responses
24-72 hours after injecting the patient, you should assign 95028 to indicate a test involving a delayed reaction. The
code includes the test result interpretation 24-72 hours later.
Skin Testing (Diagnosis)
There are a number of diagnosis codes that support skin testing. The most common are 477.0 (Allergic rhinitis; due to
pollen), but other allowable diagnoses include 477.8 (...due to other allergen), 493.00-493.02 (Asthma; extrinsic
asthma), 493.20-493.22 (... chronic obstructive asthma), 989.5 (Toxic effect of other substances, chiefly nonmedicinal
as to source; venom), and 708.0-708.1 (Urticaria).
Most carriers will not cover testing for food allergens, but if you submit a claim for this service, report a diagnosis of
477.1 (... due to food) and link it to 95199 (Unlisted allergy/clinical immunology service or procedure).
Key: If a patient comes in with typical allergy symptoms such as stuffy nose and itchy, drippy eyes, and the skin
testing comes back negative, bill the signs and symptoms (such as 478.1x, Other diseases of the respiratory tract;
other diseases of the nasal cavity and sinuses) and receive payment.
Determine the Billing Method
You should report all skin tests per antigen except 95027. Even if your physician performs multiple scratches, pricks,
punctures, or intradermal injections, you should report in the Units box how many allergens your physician tested.
Example: A physician tests a child for 10 allergens. You should bill 10 units. Even though your physician may perform
six pricks or injections for each test, you should bill only one unit per antigen.
Exception: You should bill 95027 per dilutional testing. Because the physician or technician has to read and measure
each stick for reaction, you should bill one unit of 95027 for each test or stick within each antigen.
Example: A physician tests a patient for 12 allergens and performs three dilutions per substance. You code: 95027 x
36 units.
Remember you can report a combination of dilutional testing and scratch tests. For instance, if a patient undergoes
intradermal testing for dust mites, bee venom, and Kentucky bluegrass pollen, you would report: 95027 x 2 units (for
the mites and pollen).

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.