95004

Allergy testing, percutaneous, prick/scratch/puncture, immediate type reaction, each individual allergen

CPT code 95004 describes allergy testing performed via the percutaneous method (prick, scratch, or puncture technique) to assess immediate-type hypersensitivity reactions. This test involves applying a small amount of a specific allergen extract to the skin surface, which is then pricked or scratched to allow the allergen to penetrate the epidermis. The site is then observed for a localized wheal and flare reaction, typically within 15-20 minutes, indicating a positive immediate hypersensitivity response. Each individual allergen tested using this method is reported with one unit of 95004. This code is used for diagnostic purposes to identify specific allergens contributing to allergic conditions.

Clinical Indications

  • Diagnosis of allergic rhinitis (seasonal or perennial)
  • Diagnosis of allergic conjunctivitis
  • Diagnosis of allergic asthma
  • Diagnosis of food allergies (e.g., IgE-mediated food hypersensitivity)
  • Diagnosis of insect venom allergy
  • Diagnosis of atopic dermatitis where allergen triggers are suspected
  • Evaluation for immunotherapy (allergy shots) to identify specific allergens for treatment

Procedure Steps

  1. Patient history and physical examination to determine appropriate allergens to test.
  2. Selection of appropriate test sites, typically the back or volar surface of the forearm, ensuring skin is free from dermatological conditions.
  3. Skin preparation of the test sites (e.g., cleaning with alcohol and allowing to dry).
  4. Application of individual allergen extracts (and positive/negative controls) to designated skin areas.
  5. Pricking, scratching, or puncturing the skin through each allergen droplet to introduce the allergen into the epidermis.
  6. Waiting for a specified observation period (typically 15-20 minutes) for reaction development.
  7. Measurement and documentation of the size of the wheal and flare reaction for each test site.
  8. Interpretation of results in conjunction with patient history and clinical presentation.
  9. Patient education regarding results and management plan.

Coding Guidelines

  • Code 95004 is reported 'each individual allergen.' If 15 allergens are tested, 15 units of 95004 should be reported.
  • Positive and negative controls are typically included in the allergy testing session but are generally considered integral to the procedure and not separately billable with 95004.
  • This code is for immediate-type hypersensitivity reactions (IgE-mediated). For delayed-type reactions (e.g., patch testing), different CPT codes (e.g., 95044) should be used.
  • Do not report 95004 for allergy testing performed by intradermal injection (use 95028).
  • Documentation must clearly list all allergens tested and the results (e.g., wheal and flare measurements).
  • The total number of units for percutaneous tests (95004, 95012) and intracutaneous tests (95024, 95027, 95028) performed on a single day should not exceed 80 tests per patient, as per national guidelines.
  • Payment for the supply of the allergen extract is often included in the payment for the professional service, or it may be separately billable using codes like 95144-95170, depending on payer policies and specific circumstances (e.g., professional vs. institutional setting).

Associated ICD-10 Codes