Summary & Overview
CPT 95076: Allergy Testing for Foods, Drugs, and Other Substances
CPT code 95076 denotes an allergy diagnostic test used to identify foods, drugs, or other substances that provoke an allergic reaction in a patient. Nationwide, allergy testing supports clinical decision-making for allergy management, avoidance strategies, and targeted treatments, making accurate coding and coverage understanding important for providers and payers. Key national payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what CPT code 95076 represents, typical sites of service, and the clinical context for its use. The publication summarizes common billing considerations, payer coverage patterns, and benchmarks where available. It also outlines relevant policy updates and claims-handling practices that affect reimbursement and utilization. Clinical context clarifies when such allergy testing is typically indicated and how it integrates into broader allergy care pathways. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 95076 describes a diagnostic procedure in which a provider performs testing to identify specific foods, drugs, or other substances that trigger an allergic response in an individual. This service is an allergy testing procedure used to detect hypersensitivities by exposing the patient to suspected allergens under controlled conditions and observing clinical or immunologic reactions.
-
Service type: Allergy diagnostic testing
-
Typical site of service: Allergy clinic, outpatient clinic, or physician office where allergy testing is performed under supervision
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual referred to an allergy/immunology clinic for evaluation of suspected IgE-mediated hypersensitivity to foods, medications, or environmental agents. The clinician performs 95076 (intradermal or intracutaneous testing to identify specific allergen triggers) after reviewing history of immediate-type reactions such as urticaria, angioedema, anaphylaxis, or recurrent respiratory symptoms linked temporally to exposures. The workflow includes pre-test assessment (medication review, discontinuation of interfering antihistamines), informed consent, baseline vital signs, and establishment of emergency measures. The provider prepares allergen extracts, performs skin prick testing as indicated, and then administers intradermal injections at graded concentrations for suspected allergens, observing for wheal-and-flare responses at standard intervals (typically 15–20 minutes). Test results are documented with wheal sizes and interpretation, and the encounter includes counseling on avoidance strategies, emergency action plans, and consideration of confirmatory testing or immunotherapy planning. Typical sites of service include outpatient allergy clinics, physician offices, ambulatory surgical centers, and specialty infusion centers when testing is part of broader allergy evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure |