The Medicare fee schedule is a reliable benchmark for tracking overall reimbursement trends of the insurance industry. To take a deep dive into how the physician fee schedule (PFS) has evolved from 2016 to 2026, we have chosen the Medicare Fee Schedule for the Washington, D.C. area and reviewed nonfacility (office-based) rates.
Note on Geography: While the Geographic Practice Cost Index (GPCI) adjusts rates by state to account for the cost of living, the underlying trends remain consistent nationwide; each CPT code follows the same RVU (Relative Value Unit) allotment and annual conversion factor.
Read on for a closer look at our findings over the past decade of asthma and allergy billing, where reimbursement has moved away from procedural diagnostics and toward clinical management/cognitive work.
Decreases in Diagnostic Fees
Data from 2016 to the 2026 rates show a consistent reduction in reimbursement for common diagnostic tests. Gone are the days of the $8 a unit skin test!
- Allergy Skin Testing (95004): In 2016, the rate was $8.17 per unit. By 2026, the rate is projected to be $4.26. This represents a 48% reduction in the value of this service over a decade.
- Spirometry (94010): Fees for basic pulmonary function testing decreased from $43.12 to $34.27, a 20% drop.
- Patch Testing (95044): Reimbursement for patch testing fell 15%, moving from $6.93 to $5.88.
These figures indicate that high-volume testing no longer carries the same financial weight it did ten years ago.
Growth in Office Visits (E/M)
While diagnostic rates have fallen, Evaluation and Management (E/M) codes have seen substantial increases, particularly following the 2021 coding updates. 2021 was the year of significant change to CMS’ definition of each level of E&M care and represents the single largest increase of the decade. Following the 2021 highs, many rates entered a 3-year “red zone” (2022–2025) as Medicare adjusted conversion factors. The projection for 2026 mostly shows a universal return to green across these specific codes. This is partly due to the new dual conversion factor system in 2026, which provides a higher baseline for practitioners participating in Qualifying APMs ($33.59).
- Established Patient Visits:
- 99213 rose from $83.29 in 2016 to $106.56 in 2026 (28% increase).
- 99214 rose from $122.29 to $151.49 (24% increase).
- 99215 rose from $164.37 to $214.58 (30% increase).
- New Patient Visits:
- 99204 increased from $187.38 to $197.64 (5% increase).
- 99205 increased from $234.40 to $263.69 (13% increase).
The trend reflects a policy shift that places higher value on the time and medical decision-making involved in managing chronic conditions like asthma and complex allergies.
The Complexity Add-On: G2211
This shift toward cognitive work is further emphasized by HCPCS code G2211, an add-on code for the “longitudinal, ongoing care” of complex conditions.
- Billing Rule: G2211 can only be billed with an E/M visit when the provider is the “focal point” of the patient’s care.
- Restriction: It cannot be billed when Modifier 25 is required (i.e., when a separate procedure, like skin testing, is performed on the same day). This effectively forces a choice: prioritize the procedure or the clinical management.
Immunotherapy Trends
Immunotherapy preparation has also seen an upward trend in reimbursement. CPT 95165 (Preparation and provisioning of antigens) increased from $15.23 in 2016 to $20.58 in 2026, a total increase of 35%. This provides a more stable revenue stream compared to the volatility seen in skin testing. The increase in 95165 reimbursement has helped offset the dramatic increase in overhead that physicians take on when purchasing the antigens required for immunotherapy mixes.
Summary of 10-Year Changes
| CPT Code | Service | 2016 Fee | 2026 Fee (Est) | % Change |
| 95004 | Percutaneous Allergy Test | $8.17 | $4.26 | -47.9% |
| 94010 | Spirometry | $43.12 | $34.27 | -20.5% |
| 95165 | Immunotherapy Prep | $15.23 | $20.58 | +35.1% |
| 99213 | Established Office Visit (Level 3) | $83.29 | $106.56 | +27.9% |
| 99214 | Established Office Visit (Level 4) | $122.29 | $151.49 | +23.9% |
Operational Considerations
The current data suggest that the long-term sustainability of an allergy practice depends on two factors:
- E/M Documentation: Since office visit fees are rising while testing fees fall, accurate documentation is necessary to ensure the level of service matches the medical complexity of the patient.
- Workflow Efficiency: With a 48% drop in skin testing reimbursement, the cost of supplies and staff time to perform these tests must be monitored closely to remain profitable.
- Immunotherapy Limitations: While Medicare has increased reimbursement for CPT 95165 – we know that there are plenty of practitioners out there that have never re-negotiated contract rates with commercial insurance carriers. Medicare may be the benchmark – but unless pressure is applied to the rest of a practitioner’s payer mix, there could be damaging consequences. The suppliers are passing on the costs to the practitioners, while insurance payments may remain stagnant. Alternately – commercial payers may have a steady unit reimbursement, but impose strict definitions of what constitutes a unit and how many units can be billed in a given period. Without close attention to these nuances, it is easy for the overhead cost to exceed reimbursement – let alone clinical staff time and overall office expense.
Check out the complete rate table below:
Explore the PFS further via CMS’ lookup tool: PFS Look-up Tool Overview | CMS