The Advocacy Council regularly receives queries from members on how to correctly code specific scenarios. Recently we received a request asking:
Question:
Can I bill Medicare for negative and positive (histamine) controls for allergy testing?
Answer:
According to the 2025 NCCI Medicare Policy Manual, CMS does not allow billing for controls for any of the following codes: 95004, 95017, 95018, and 95024.
The 2025 NCCI Medicare Policy Manual Section 18 MUE states:
“Some allergy testing CPT codes (e.g., 95004, 95017-95052) are reported based on the number of individual tests performed. CMS payment policy does not allow including testing of positive or negative controls in the number of tests reported. For example, if percutaneous testing (CPT code 95018) with penicillin allergens administering 6 allergens plus a positive and negative control is performed, only 6 tests may be reported for CPT code 95018.”
Commercial carriers may have different policies on billing for controls. We encourage you to check with your payers.
Do you have a coding conundrum of your own? Share it with us!
