Summary & Overview
CPT 95028: Delayed-Type Allergy Skin Test with Interpretation and Report
CPT code 95028 covers delayed-type skin testing for allergic sensitization: the administration of allergenic extracts into the skin, clinical interpretation of delayed reactions, and a written report documenting the number of tests. This procedure is an important diagnostic tool for identifying cell-mediated allergic responses and informs management in allergy and immunology care.
Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and coding intent, typical sites of service, common modifiers associated with procedural reporting, and notes on billing practice considerations when available. The publication highlights benchmarks and policy-relevant issues affecting reimbursement and coverage determinations at a national level, and summarizes what clinicians and coding professionals need to know about documentation and reporting for 95028.
The piece is designed for a national audience and frames 95028 within outpatient allergy/immunology practice, helping billing staff, compliance officers, and clinicians understand the procedure’s coding purpose, reporting expectations, and areas where payer policies commonly affect claims adjudication.
Billing Code Overview
CPT code 95028 describes a skin test procedure in which a provider introduces allergenic extracts into the skin to evaluate for a delayed allergic response, interprets the findings, and documents results in a written report specifying the number of tests performed.
Service Type: Allergy skin testing (delayed hypersensitivity testing)
Typical Site of Service: Outpatient clinic or office-based allergy/immunology setting, including specialty clinics where skin testing and interpretation are performed.
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Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to an outpatient allergy clinic with a 6-month history of eczematous dermatitis and suspected allergic contact dermatitis after topical cosmetics exposure. Prior patch testing is indicated to identify delayed (type IV) hypersensitivity to suspected allergens. The clinical workflow: the patient is registered, a focused history and relevant medication review are completed, and prior lesion sites are documented. The clinician applies standardized allergenic extracts in chambers or strips to the patient’s back, records the number and identity of test allergens, and instructs the patient to avoid wetting the area. At the 48-hour and often 72- or 96-hour readings, the provider interprets skin findings, documents positive, doubtful, and negative reactions using standardized grading, and composes a written report specifying the number of tests performed and clinical interpretation. Typical settings are outpatient dermatology or allergy/immunology clinics and ambulatory surgical centers when facility resources are used. Patient counseling and management recommendations are documented after interpretation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Principal physician of record or primary performing practitioner | When the reporting provider is the primary clinician directing care for the visit including test interpretation |
22 | Increased procedural services | When the complexity or time to interpret and report an unusually extensive number of patch test allergens significantly increases work |
26 | Professional component | When only the physician interpretation and report are billed separate from facility or technical services |
52 | Reduced services | When testing was started but fewer patches were placed than usual due to patient intolerance |
53 | Discontinued procedure | When patch testing is discontinued before application because of contraindication identified at time of visit |
59 | Distinct procedural service | When the patch test interpretation is separately identifiable from other procedures performed on the same day |
76 | Repeat procedure by same physician | When an identical patch testing procedure is repeated by the same provider during the postoperative period or on the same date for a separate indication |
78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure | When a complication requires returning to a procedure area to revise or remove patch test materials (rare) |
80 | Assistant surgeon | If an assistant surgeon or clinician provided substantive assistance during application in a procedural setting |
TC | Technical component | When the facility or testing center bills for supplies, patch materials, and technical application but the physician bills separately for interpretation |
QX | Modifier – CR modifier for assistant when CRNA/assistant surgeon requirements met (if applicable) | When a qualified non-physician performs billable assistance under applicable payer rules |
GC | Staff physician attestation of clinical service | When a resident performed the application and an attending physician signed off on the interpretation and report |
SH | Scope of residency training – service performed by resident and teaching physician not present | When allowed by payer policy and documentation supports resident-performed service without the teaching physician present |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207K00000X | Allergy & Immunology | Most common specialty performing patch and delayed hypersensitivity testing |
207N00000X | Dermatology | Frequently performs patch testing for contact dermatitis and skin-related delayed hypersensitivity |
2084P0800X | Pediatric Allergy | Pediatric specialists perform testing in children when indicated |
207R00000X | Internal Medicine | Generalists who provide allergy testing in some outpatient clinics |
207L00000X | Family Medicine | May perform patch testing in primary care settings with appropriate training |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L23.9 | Allergic contact dermatitis, unspecified cause | Common indication for patch testing to identify causative contact allergens |
L24.9 | Irritant contact dermatitis, unspecified | Patch testing may be used to rule out allergic causes when irritant dermatitis is suspected |
L30.9 | Dermatitis, unspecified | Used when dermatitis is present but specific etiology remains unclear pending testing |
T78.4XXA | Allergy, unspecified, initial encounter | Applied when allergic etiology is considered and testing is undertaken to identify triggers |
Z13.6 | Encounter for allergy testing | Administrative code used when the primary purpose of the visit is diagnostic allergy testing |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
95044 | Application and reading of patch or photopatch test, first day interpretation only | Used when patch application and an initial reading are billed separately or when limited to initial assessment |
95045 | Application and reading of patch or photopatch test, each additional reading | Billed for subsequent readings (for example 72- or 96-hour) in addition to the first reading when separately reportable |
95060 | Intracutaneous (intradermal) tests with subsequent readings, single or multiple antigens, including interpretation and report | Performed for immediate hypersensitivity testing (type I) and may be performed in the same visit or separately when evaluating mixed allergic presentations |
95024 | Intradermal tests for TB (Mantoux) – interpretation and report only | Relevant when evaluating multiple causes of dermatitis or when tuberculosis testing is contemporaneously required; represents interpretation-only reporting |
99024 | Postoperative follow-up visit, typically used for minor procedures | May be used for subsequent visit codes when billing regular follow-up related to the testing episode |