Patch testing for contact allergy, billed per individual allergen patch applied to the skin, with reading of the results.
- Medicare
- $5.01
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- History supporting testing (jewelry or metal reaction, unexplained pain or effusion after arthroplasty)
- List of each allergen applied, matching the units billed
- Application date and reading dates
- Result for each patch with grading
- Interpretation and implications for implant selection
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
95044 is allergy patch testing, reported per test. Each allergen applied counts as one unit. The patches stay on for about 48 hours and are read at removal and again a few days later.
Orthopedic practices encounter this with suspected metal hypersensitivity. A patient with a history of reacting to cheap jewelry may be tested for nickel, cobalt, and chromium before a total knee, and some surgeons order testing when a painful arthroplasty has no mechanical or infectious explanation. Some panels add bone cement components. The testing is usually done by dermatology or allergy, not the surgeon.
Bill the number of patches as units on one line. The readings are part of the code, so a separate E/M for the reading visit is not billed unless there is a distinct, documented problem addressed. Payers often question metal panels done routinely before arthroplasty without a history of reaction, so the note should state the history.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0.14 |
| Malpractice RVU | 0.01 |
| Total RVU | 0.15 |
| Medicare national rate | $5.01 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $5.01 |
HOPD (APC 5724) Hospital outpatient department | $877.34 |
Common denial reasons
The recurring reasons claims for CPT 95044 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Units billed do not match the number of allergens documented
- Routine preop metal testing with no reaction history
- Separate E/M billed for the reading visit with no distinct problem
- Missing reading results
- Diagnosis does not support allergy testing
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How are units counted for 95044?
02Is patch testing covered before knee replacement for metal allergy?
03Can I bill an office visit when reading the patches?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures a patient's metal reaction history and unexplained post-arthroplasty symptoms in the note, giving patch testing a documented clinical reason.
See how Mira captures CPT 95044 documentation