CPT 95024 Intradermal Testing Reimbursement | OpenPayer

Summary & Overview

CPT 95024: Intradermal Allergy Testing, Immediate Reaction

CPT code 95024 represents intradermal allergy testing with allergenic extracts to assess immediate type reactions. This procedure is a cornerstone in allergy and immunology practices, providing critical information for diagnosing allergic conditions such as conjunctivitis, rhinitis, and sinusitis. The code is widely recognized and reimbursed by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare.

This publication offers a comprehensive overview of 95024, covering payer coverage, clinical context, and related coding considerations. Readers will gain insights into typical sites of service, common clinical indications, and associated diagnoses. The analysis also highlights relevant modifiers and taxonomies, as well as related CPT codes for allergy testing procedures. Policy updates and reimbursement benchmarks are discussed to inform stakeholders about current trends and requirements in allergy testing.

Healthcare professionals, billing specialists, and policy analysts will find this resource valuable for understanding the national landscape of intradermal allergy testing, ensuring accurate coding, and staying informed about payer policies and clinical guidelines.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 95024allergy testingintradermal testimmediate reactionoffice proceduresclinical codingallergy and immunologyreimbursementpolicy updatediagnostic services

CPT Code Overview

CPT code 95024 is used to report intradermal allergy testing procedures with allergenic extracts, specifically for immediate type reactions. This service is typically performed in an office setting and is a key diagnostic tool for identifying allergic sensitivities in patients. The procedure involves injecting small amounts of allergenic extracts into the skin and observing for an immediate reaction, which helps clinicians determine specific allergens responsible for symptoms. Intradermal testing is commonly utilized when percutaneous tests are inconclusive or when a more sensitive assessment is required.

Clinical & Coding Specifications

Clinical Context

A patient presents to the office with symptoms suggestive of allergic conditions, such as persistent sneezing, nasal congestion, itchy or watery eyes, or chronic sinus issues. The provider, typically an allergy and immunology specialist, evaluates the patient and determines that allergy testing is warranted to identify specific allergens responsible for the symptoms. The provider performs intracutaneous (intradermal) tests using allergenic extracts, observing for immediate type reactions. The number of tests performed is specified, and the results help guide further management of the patient's allergic condition. This procedure is commonly performed in an office setting (Place of Service 11).

Coding Specifications

Modifier 59: Used to indicate a distinct procedural service, when the procedure is separate from other services performed on the same day.
Modifier 76: Used when the same procedure is repeated by the same physician or other qualified health care professional.

Modifier Code	Description
`59`	Distinct Procedural Service

National Reimbursement Benchmarks

Nationally, the mean rate for CPT code 95024 is highest with Aetna at $24.28, while Medicare's mean rate stands at $7.99. The average commercial benchmark (BUCA) is $10.90, which is notably higher than Medicare but significantly lower than Aetna. Blue Cross Blue Shield, Cigna, and UnitedHealth Group all cluster closer to Medicare, with mean rates ranging from $6.34 to $8.85.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the tightest range ($1.00), indicating minimal variation in rates. In contrast, UnitedHealth Group shows the widest dispersion ($5.00), followed by Cigna ($4.12) and Aetna ($3.33), reflecting greater variability in commercial reimbursement. The table and chart below present the full breakdown of national benchmarks for each payer.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a wide spread in reimbursement rates for CPT code 95024, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($8.45), followed by BUCA ($8.03). In contrast, Aetna's rates are tightly clustered, with no spread between percentiles. Compared to national averages, most commercial payers in Alaska offer higher mean rates, notably Blue Cross Blue Shield and UnitedHealth Group, while Cigna and Medicare are close to their national benchmarks.

The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the variability and relative positioning of each payer in the state market.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 95024 in Alaska, with a mean rate of $15.12.
Medicare and Cigna offer the lowest mean rates in Alaska, at $7.65 and $7.90 respectively.
Most commercial payers in Alaska reimburse at rates above their national averages, with the exception of Cigna, which is nearly identical to its national mean.

CPT 95017: Allergy Skin Testing (Prick, Scratch, Intradermal, Venom)

CPT-95052-PHOTO-PATCH-TESTING-WITH-PATCH-TEST

CPT 95052: Photo Patch Testing with Patch Test, Allergy Diagnostic

CPT-95018-SEQUENTIAL-INCREMENTAL-DRUG-BIOLOGIC-SKIN-TEST

CPT 95018: Sequential Incremental Drug and Biologic Skin Test

CPT-95044-PATCH-TEST-ALLERGIC-REACTION

CPT 95044: Patch Testing for Allergic Skin Reaction

CPT-95070-BRONCHIAL-CHALLENGE-TEST-TECHNICAL-COMPONENT

CPT 95070: Bronchial Challenge Test, Technical Component

CPT-95012-EXHALED-NITRIC-OXIDE-FE-NO-TESTING-FOR-AIRWAY-INFLAMMATION

CPT 95012: Exhaled Nitric Oxide Test for Airway Inflammation

CPT-95056-PHOTO-TEST-ALLERGENIC-EXTRACT-PHOTODERMATITIS

CPT 95056: Phototest with Allergenic Extract for Photoallergy

CPT-95028-ALLERGY-DELAYED-SKIN-TEST-INTERPRETATION-REPORT

CPT 95028: Delayed-Type Allergy Skin Test with Interpretation and Report

CPT-95027-AIRBORNE-ALLERGEN-SKIN-PRICK-TESTING-INTERPRETATION

CPT 95027: Percutaneous Airborne Allergen Skin Prick Testing with Interpretation

CPT-95004-PERCUTANEOUS-ALLERGEN-SKIN-TEST

CPT 95004: Percutaneous Allergen Skin Test

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Taxonomy Code	Specialty Name
`207K00000X`	Allergy & Immunology Physician
`207RA0201X`	Allergy Physician
`207RI0008X`	Clinical & Laboratory Immunology Physician

Related Diagnoses

H10.11: Acute atopic conjunctivitis, right eye
- Relevant for patients with allergic eye symptoms, may prompt allergy testing.
H10.12: Acute atopic conjunctivitis, left eye
- Indicates allergic conjunctivitis in the left eye, supporting the need for allergen identification.
H10.13: Acute atopic conjunctivitis, bilateral
- Bilateral allergic conjunctivitis, often associated with environmental allergens.
H10.411: Chronic giant papillary conjunctivitis, right eye
- Chronic allergic eye condition, may require allergy testing to identify triggers.
H10.412: Chronic giant papillary conjunctivitis, left eye
- Chronic allergic conjunctivitis in the left eye, relevant for allergy evaluation.
H10.413: Chronic giant papillary conjunctivitis, bilateral
- Bilateral chronic allergic conjunctivitis, supports allergy testing.
H10.419: Chronic giant papillary conjunctivitis, unspecified eye
- Unspecified chronic allergic conjunctivitis, may benefit from allergen testing.
H10.44: Vernal conjunctivitis
- Allergic conjunctivitis often seen in children, relevant for allergy testing.
H10.45: Other chronic allergic conjunctivitis
- Other forms of chronic allergic conjunctivitis, supports allergy evaluation.
J30.0: Vasomotor rhinitis
- Non-allergic rhinitis, sometimes tested to rule out allergic causes.
J30.1: Allergic rhinitis due to pollen
- Common allergic condition, direct indication for allergy testing.
J30.2: Other seasonal allergic rhinitis
- Seasonal allergies, often tested to identify specific allergens.
J30.81: Allergic rhinitis due to animal (cat) (dog) hair and dander
- Allergic reactions to animal dander, relevant for targeted allergy testing.
J30.89: Other allergic rhinitis
- Other forms of allergic rhinitis, supports the use of allergy testing.
J30.9: Allergic rhinitis, unspecified
- Unspecified allergic rhinitis, may require testing to determine cause.
J31.0: Chronic rhinitis
- Chronic nasal symptoms, allergy testing may help identify underlying allergens.
J32.0: Chronic maxillary sinusitis
- Chronic sinusitis, often associated with allergies, supports testing.
J32.1: Chronic frontal sinusitis
- Chronic sinusitis in the frontal sinuses, may be related to allergic triggers.
J32.2: Chronic ethmoidal sinusitis
- Chronic ethmoidal sinusitis, allergy testing may be indicated to identify causes.

OpenPayer

Summary & Overview

CPT 95024: Intradermal Allergy Testing, Immediate Reaction

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes