How much does Medicare pay for CPT 95004?

Medicare allowed an average of $3.65 per service and paid $2.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $13.08, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95004?

Test for allergy using allergenic extract. It was billed 7,654,997 times to 133,456 Medicare beneficiaries by 3,637 providers in 2024.

Does 95004 pay differently in an office than a hospital?

Yes. The allowed amount averaged $3.65 in an office setting and $3.69 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95004 most?

Allergy/ Immunology, with 4,791,650 services from 2,114 clinicians. Next are Otolaryngology, Internal Medicine, Nurse Practitioner.

CPT 95004

Test for allergy using allergenic extract

$3.65Medicare-allowed amount per service, averaged across 7,654,997 services

Providers submitted

$13.08

Asking price, not received

Medicare allowed

$3.65

The fee schedule figure

Medicare paid

$2.81

Balance is patient coinsurance

Providers submitted an average of $13.08 for this code and Medicare allowed $3.65 — 3.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $2.81 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $3.65
Hospital / facility: $3.69

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 7,607,191 services were billed in an office setting and 47,806 in a facility.

Services: 7,654,997
Beneficiaries: 133,456
Providers billing it: 3,637
Total allowed: $27,940,739

What Medicare pays for CPT 95004

Across 7,654,997 services billed by 3,637 providers to 133,456 beneficiaries, Medicare allowed an average of $3.65 per service. That is 57.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95004

Specialty	Services	Beneficiaries	Avg allowed	Providers
Allergy/ Immunology	4,791,650	85,386	$3.65	2,114
Otolaryngology	874,786	18,038	$3.57	687
Internal Medicine	489,797	7,133	$3.90	166
Nurse Practitioner	429,317	6,873	$3.01	261
Pulmonary Disease	170,829	2,573	$3.88	62
Physician Assistant	152,968	2,914	$3.06	128
Family Practice	131,114	2,046	$3.65	81
General Practice	129,169	1,484	$3.85	14
Ophthalmology	126,553	1,891	$4.27	29
Pediatric Medicine	56,830	1,034	$3.67	34
Dermatology	44,178	641	$3.88	11
Obstetrics & Gynecology	40,356	472	$3.75	3
Independent Diagnostic Testing Facility (IDTF)	34,520	431	$4.49	3
Neurology	33,553	421	$4.05	3
Cardiology	21,677	273	$4.23	5

95004 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,317,566	$3.96	$2.77	345
New York	834,425	$4.38	$2.79	279
Florida	773,842	$3.67	$2.74	323
Texas	677,535	$3.41	$2.75	372
Arizona	350,038	$3.36	$2.69	113
New Jersey	306,840	$4.09	$2.79	150
Virginia	225,555	$3.50	$2.73	123
Tennessee	204,960	$3.01	$2.67	116
North Carolina	186,993	$3.23	$2.74	111
Ohio	184,770	$3.28	$2.70	91
South Carolina	175,104	$3.26	$2.72	83
Georgia	173,347	$3.37	$2.73	115
Pennsylvania	171,013	$3.52	$2.74	115
Kentucky	167,119	$3.17	$2.77	61
Maryland	163,148	$3.86	$2.72	90
Illinois	156,897	$3.78	$2.72	119
Michigan	142,059	$3.57	$2.77	83
Massachusetts	139,456	$3.73	$2.70	93
Indiana	119,448	$3.15	$2.68	62
Missouri	117,382	$3.22	$2.72	64
Colorado	104,537	$3.56	$2.70	60
Arkansas	83,666	$2.99	$2.73	34
Nevada	73,226	$3.38	$2.69	27
Washington	69,661	$3.65	$2.67	57
Iowa	63,681	$3.06	$2.70	33
Oklahoma	55,043	$3.13	$2.73	30
Louisiana	47,674	$3.24	$2.79	36
Delaware	47,438	$3.53	$2.73	21
Connecticut	46,999	$3.85	$2.64	42
Alabama	42,243	$3.02	$2.74	39
Minnesota	36,705	$3.44	$2.63	41
Utah	34,107	$3.27	$2.76	26
Mississippi	34,008	$3.03	$2.80	26
Kansas	33,648	$3.03	$2.66	24
New Mexico	32,926	$3.27	$2.73	19
Oregon	31,995	$3.33	$2.55	32
Idaho	29,500	$2.95	$2.57	18
Wisconsin	28,951	$3.18	$2.66	39
Nebraska	28,902	$3.14	$2.64	22
West Virginia	26,963	$3.16	$2.77	12
Hawaii	15,367	$3.84	$2.80	6
Rhode Island	14,067	$3.59	$2.77	6
New Hampshire	14,024	$3.71	$2.73	11
South Dakota	13,702	$3.25	$2.62	15
Montana	11,004	$3.36	$2.55	10
Maine	10,976	$3.49	$2.66	11
Alaska	9,934	$3.74	$2.71	9
Vermont	7,247	$3.24	$2.61	3
District of Columbia	6,835	$3.83	$2.78	6
North Dakota	6,375	$3.38	$2.44	6
Wyoming	3,679	$3.22	$2.59	5
Puerto Rico	2,417	$3.59	$2.74	3

Related codes

95024Test for allergy$7.59
95044Test for allergy$5.08
95012Test to measure the level of nitric oxide gas$19.39
95027Test for allergy$4.88
95018Test for allergy$17.77
95076Test for allergy$110.90
95070Test for allergy$34.15

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.