How much does Medicare pay for CPT 95018?

Medicare allowed an average of $17.77 per service and paid $13.75 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $71.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95018?

Test for allergy using combination of methods with drug or biological. It was billed 34,327 times to 4,610 Medicare beneficiaries by 217 providers in 2024.

Does 95018 pay differently in an office than a hospital?

Yes. The allowed amount averaged $19.48 in an office setting and $7.08 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 95018 most?

Allergy/ Immunology, with 26,910 services from 185 clinicians. Next are Internal Medicine, Physician Assistant, Nurse Practitioner.

CPT 95018

Test for allergy using combination of methods with drug or biological

$17.77Medicare-allowed amount per service, averaged across 34,327 services

Providers submitted

$71.91

Asking price, not received

Medicare allowed

$17.77

The fee schedule figure

Medicare paid

$13.75

Balance is patient coinsurance

Providers submitted an average of $71.91 for this code and Medicare allowed $17.77 — 4.0× 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 $13.75 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $19.48
Hospital / facility: $7.08

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 29,595 services were billed in an office setting and 4,732 in a facility.

Services: 34,327
Beneficiaries: 4,610
Providers billing it: 217
Total allowed: $609,991

What Medicare pays for CPT 95018

Across 34,327 services billed by 217 providers to 4,610 beneficiaries, Medicare allowed an average of $17.77 per service. That is 7.4 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 95018

Specialty	Services	Beneficiaries	Avg allowed	Providers
Allergy/ Immunology	26,910	3,738	$18.27	185
Internal Medicine	2,744	134	$17.74	5
Physician Assistant	1,972	242	$14.51	6
Nurse Practitioner	1,592	248	$12.40	12
Pediatric Medicine	351	44	$22.19	2
Pulmonary Disease	321	42	$16.46	2
Otolaryngology	265	116	$19.42	4
Dermatology	172	46	$18.53	1

95018 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
Massachusetts	4,864	$16.39	$11.76	28
New Jersey	3,935	$15.41	$10.83	28
Florida	3,592	$19.37	$15.11	19
New York	3,454	$23.27	$15.32	27
Texas	2,816	$17.63	$15.50	6
Minnesota	2,654	$17.90	$13.39	11
California	2,100	$18.78	$13.12	17
Illinois	1,612	$11.70	$8.30	10
Pennsylvania	1,130	$18.17	$14.03	10
Maryland	922	$18.45	$12.15	6
Ohio	637	$16.59	$12.40	4
South Carolina	585	$18.22	$15.06	3
North Dakota	562	$19.06	$15.61	2
Wisconsin	461	$18.09	$14.68	4
Tennessee	406	$16.77	$15.47	4
Missouri	402	$19.10	$15.41	2
Arizona	391	$17.42	$13.81	3
Iowa	359	$17.86	$15.58	3
Nebraska	315	$6.85	$6.31	2
Kentucky	312	$17.22	$15.79	2
Colorado	304	$19.14	$14.59	3
Delaware	295	$17.88	$13.30	2
Indiana	232	$17.87	$13.86	2
Georgia	222	$18.18	$15.13	2
Connecticut	218	$20.69	$15.61	2
Maine	215	$14.36	$10.68	2
Kansas	178	$18.09	$15.63	1
New Mexico	157	$17.82	$14.78	1
Vermont	155	$18.39	$15.61	1
Oregon	132	$17.15	$13.29	1
Michigan	123	$19.77	$14.72	1
South Dakota	119	$19.46	$15.64	1
Mississippi	110	$17.17	$15.56	1
Virginia	86	$19.30	$15.62	1
Alabama	66	$18.32	$15.64	1
Puerto Rico	64	$19.47	$13.21	1
Louisiana	59	$17.85	$15.62	1
Washington	52	$20.09	$14.36	1
North Carolina	31	$15.61	$12.57	1

Related codes

95004Test for allergy$3.65
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
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.