2025 CPT code 95004
Effective Date: N/A Revision Date: N/A Medicine Services and Procedures > Allergy and Clinical Immunology Procedures Feed
Percutaneous allergy tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report.
Modifier 25 can be appended to an E/M code if a significant, separately identifiable E/M service is performed on the same day as the allergy testing. Modifier 52 can be used if the service is reduced. Modifier 53 should be used if the procedure is discontinued.
Medical necessity for this procedure must be established by appropriate diagnostic procedures coordinated with clinical judgment and knowledge of the natural history of allergic diseases. Documentation should support the reason for the allergy testing (e.g., symptoms, suspected allergens) and the clinical relevance of the chosen allergens.
The physician is responsible for obtaining informed consent, performing the percutaneous tests, interpreting the results, and providing a report. The physician must also counsel the patient on allergen avoidance and treatment, including the use of an epinephrine auto-injector if necessary. Administration of medications for severe allergic reaction is reported separately.
In simple words: This is a skin test for allergies. Small amounts of different allergens are placed on the skin, usually on the forearm or back, by making tiny pricks or scratches. The doctor then observes the skin for reactions like redness or swelling to determine if you are allergic to any of the substances. The results are then interpreted and a report is created.
This code represents percutaneous allergy tests, including scratch, puncture, or prick tests, performed with allergenic extracts to identify immediate-type reactions. The service includes test interpretation and report by a physician. The number of tests performed should be specified.
Example 1: A patient presents with suspected environmental allergies. The physician performs 40 percutaneous tests with allergenic extracts to identify specific allergens. 40 units of 95004 are reported., A patient has a history of food allergies. The physician performs percutaneous tests with 20 food allergenic extracts and 20 environmental allergenic extracts. 40 units of 95004 are reported., A patient is suspected of having both food and environmental allergies. The physician performs 30 percutaneous tests for environmental allergens, and then, after reviewing those results, performs 10 tests for food allergens. A total of 40 units of 95004 are reported.
Documentation should include the number and type of allergens tested, the patient's reaction to each allergen (including size of wheal, if applicable), and the interpretation of the results. Informed consent should also be documented. If an E/M service is billed with modifier 25, the documentation should support a significant and separately identifiable service beyond the allergy testing.
- Specialties:Allergy and Immunology
- Place of Service:Office