How much does allergy testing cost?
What patients really want to know is: “How much will I have to pay for allergy testing?” These 2 questions are quite different in this world of complicated health insurance.
For the sake of simplifying these questions, I will use an example:
- Allergy doctor A: fee for allergy skin test is $9 per test
- Allergy doctor B: fee for allergy skin test is $15 per test
- Allergy doctor C: fee for allergy skin test is $30 per test
The health insurance company that has contracted with each allergy doctor has an allowable fee for allergy skin test of $12 per test.
How much will doctor A, B, and C be paid by the health Insurance company?
- Allergy doctor A will receive $9 for each test
- Allergy doctors B and C will each receive $12 for each test because that is maximum allowable under the contract with the health insurance. The remaining amount above the allowed amount is “un-allowed.” Bottom line: it does not matter how much the doctor “charges” for the allergy test—the insurance carriers are only going to pay the amount allowed and no more!
Back to the real question:
How much will the patient pay out-of-pocket?
This depends on the:
- Deductible: the amount of money the patient pays before the insurance company begins to pay any amount as required by their specific plan they choose (gold, silver, bronze, etc)
- Co-Pay: the amount the patient is required to pay per visit according to the insurance plan the patient has with the insurance carrier.
- Co-insurance: the amount the patient is required to pay according to a percentage (ex: visit is 80/20—- insurance company pays 80% and patient pays 20%
What should you do?
Call your health insurance company and ask them the allowable fee for the specific CPT test code (CPT stands for Current Procedural Terminology) for the tests you are interested in (see below)! Again, it really does not matter what the fee is from the doctor’s office. What matters is what amount the insurance company allows.
- Allergy skin test: code 95004: this is the code for the “scratch test” now called prick or puncture test that is commonly used to check for environmental and food allergies. The number of tests performed is determined at the visit based on each individual’s specific needs and discussed with the physician before testing is performed.
- Allergy skin test: code 95024: this is the code for the skin test where a small needle injection is performed under the skin. This is sometimes performed when the “scratch test” is negative but the history suggests an allergy. This step is generally not performed on young children and NOT used for food testing.
- Allergy patch testing 95044: this is the code used for evaluating skin rashes called “contact dermatitis” such as nickel allergy or skin rashes from chemicals, dyes, rubber products, perfumes, make up etc. Patch testing kits typically come as a grouping with 36 tests for example rather than individually.
- Penicillin skin testing: code 95018. This testing requires a combination of “scratch” testing and intradermal (needle) testing with generally 11 tests performed. Typically, 2 preparations are used (PrePen® and Penicillin G).
- Venom skin testing: code 95017. This testing also requires a combination of “scratch” testing and intradermal (needle) skin testing and performed to the most common stinging insects such as yellow jacket, wasp, white and yellow-faced hornets and honey bees. In the southern U.S., fire ant testing is available as well.
So……to make life a little less stressful for you, don’t call the doctor’s office and ask how much they charge….instead, call your health insurance company and ask them how much they allow for testing based on the above CPT codes and the specifics of your current insurance plan—then YOU KNOW!!
Now you can choose your allergist (or any health care provider) based on important characteristics (experience, board certification, thoroughness, bedside manner, qualifications) and not COST.
At Family Allergy & Asthma Care of Montana, we are here to help you navigate the healthcare issues that affect your bottom line.
This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.