How much does Medicare pay for CPT 95076?

Medicare allowed an average of $110.90 per service and paid $84.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $393.15, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95076?

Test for allergy using ingested items, initial 2 hours. It was billed 4,904 times to 4,319 Medicare beneficiaries by 242 providers in 2024.

Does 95076 pay differently in an office than a hospital?

Yes. The allowed amount averaged $117.53 in an office setting and $72.88 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 95076 most?

Allergy/ Immunology, with 3,925 services from 196 clinicians. Next are Nurse Practitioner, Physician Assistant, Internal Medicine.

CPT 95076

Test for allergy using ingested items, initial 2 hours

$110.90Medicare-allowed amount per service, averaged across 4,904 services

Providers submitted

$393.15

Asking price, not received

Medicare allowed

$110.90

The fee schedule figure

Medicare paid

$84.37

Balance is patient coinsurance

Providers submitted an average of $393.15 for this code and Medicare allowed $110.90 — 3.5× 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 $84.37 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $117.53
Hospital / facility: $72.88

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. 4,175 services were billed in an office setting and 729 in a facility.

Services: 4,904
Beneficiaries: 4,319
Providers billing it: 242
Total allowed: $543,854

What Medicare pays for CPT 95076

Across 4,904 services billed by 242 providers to 4,319 beneficiaries, Medicare allowed an average of $110.90 per service. 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 95076

Specialty	Services	Beneficiaries	Avg allowed	Providers
Allergy/ Immunology	3,925	3,434	$115.25	196
Nurse Practitioner	519	468	$91.12	21
Physician Assistant	154	137	$87.12	8
Internal Medicine	123	112	$101.70	8
Pulmonary Disease	49	45	$115.64	3
Infectious Disease	42	38	$101.13	1
Certified Clinical Nurse Specialist	41	38	$58.33	1
Pediatric Medicine	25	23	$133.32	2
Rheumatology	14	12	$115.17	1
Critical Care (Intensivists)	12	12	$82.89	1

95076 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	653	$116.65	$80.29	28
Massachusetts	626	$108.60	$75.03	24
New York	587	$133.30	$88.66	30
Florida	375	$120.53	$92.80	21
New Jersey	372	$114.12	$78.60	15
Illinois	321	$99.05	$71.72	14
Ohio	273	$73.80	$55.93	12
Wisconsin	233	$104.77	$81.69	12
Pennsylvania	231	$106.21	$78.16	12
Tennessee	148	$105.83	$93.85	7
Texas	120	$109.15	$82.29	7
North Carolina	95	$115.97	$88.85	7
Maryland	75	$89.82	$62.28	4
Delaware	73	$115.45	$86.14	4
Iowa	72	$105.26	$82.96	4
Arizona	52	$109.66	$89.82	3
Virginia	46	$88.00	$63.48	3
Maine	45	$103.95	$75.07	3
Oregon	45	$99.36	$78.02	3
Missouri	44	$111.00	$89.36	2
Connecticut	39	$110.24	$79.26	3
Alaska	37	$148.61	$87.35	2
Indiana	33	$112.10	$95.89	2
Kentucky	32	$110.17	$93.66	2
South Carolina	29	$114.21	$96.13	2
Minnesota	26	$121.81	$91.30	2
Kansas	25	$110.77	$93.83	1
South Dakota	22	$119.95	$90.93	1
Nebraska	19	$68.23	$56.80	1
Montana	19	$61.04	$48.35	1
Rhode Island	17	$117.30	$78.99	1
Vermont	16	$113.68	$96.36	1
District of Columbia	15	$131.09	$90.06	1
Mississippi	15	$109.00	$96.03	1
Washington	14	$123.60	$78.30	1
Louisiana	13	$112.40	$96.20	1
New Mexico	13	$112.62	$75.66	1
Colorado	12	$105.78	$81.73	1
Georgia	11	$113.24	$96.55	1
Alabama	11	$57.38	$48.07	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
95018Test for allergy$17.77
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.