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Ask A Rev Cycle Expert: CPT 95004 Allergy Testing?

Question:

Could you please clarify if CPT 95004 should be billed on a UB form with the number of allergen tests provided to the patient. We typically perform 24 tests as an outpatient hospital service. CPT Manual states to list the number of tests. Is CPT code a professional-only CPT code or can hospitals also report CPT 95004 code if performed in an outpatient hospital department?

Answer:

Current Procedural Terminology (CPT®) code 95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests is reportable by facilities. The code is not for professional claims only.

The code is reported per test administered, with a Medically Unlikely Edit (MUE) value of 80. If you are performing 24 tests, then you would report units of service as 24. Per coding guidelines, the number of tests administered would need to be specified. According to the guidance below, the service includes "test interpretation and report by a physician,” so the documentation would need to specifically list results for the 24 tests done.

Under the Outpatient Prospective Payment System (OPPS), the National Payment Rate is $919.82. The code is currently assigned to status indicator Q1 STV-Packaged Codes, and reimbursement will be packaged if reported on the same day as a service or procedure assigned to status indicators S, T, or V.

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).