November 17, 2022

Question:
My physician always bills an E/M service with CPT codes 95076/95079.  Is this allowed?

Answer:
It’s rare to bill an E/M code with an oral challenge unless the provider needs to treat for a reaction (intervention therapy – a separate service) or the provider saw the patient for an unrelated office visit the same day as testing.

The office visit cannot be part of the testing and needs to significantly separately identifiable. You cannot double-count the testing time for both the oral challenge and the E/M code! If you do code an E/M visit with an oral challenge, add modifier 25 to the E/M code (99202 – 99215).

*This response is based on the best information available as of 11/17/22.