95004 CPT® code: payer coverage and prior authorization95004 appears in 10 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Allergy and Hypersensitivity (0038) | covered if criteria are met | Mar 10, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered | Oct 2, 2025 | payer document |
| Aetna | Omalizumab (0670) | listed, no stance (range 95004-95079) | Aug 21, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Allergy Testing (L.2.01.428) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Allergy Testing sad CPT Code and Explanation | Type of Test | Annual Maximum | Units Explanation | covered if criteria are met | Mar 18, 2026 | payer document |
| Blue Cross NC | Allergen Testing AHS – G2031 | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Allergy Skin and Challenge Testing | listed, no stance | Nov 1, 2025 | payer document |
| Centene | Allergy Testing and Therapy (CP.MP.100) | covered if criteria are met | Sep 1, 2023 | payer document |
| Cigna | Allergy Testing and Non-Pharmacologic Treatment (0070) | covered if criteria are met | Apr 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Medical Policies Moving to MCG Guidelines Spectrum Disorders (ASD) | 70460, 70470, 70496, 70551, | Disorders – Gene Panels | listed, no stance | Jan 1, 2026 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.