Allergy and Immunology Medical Billing Services by Prospect Healthcare Solutions
Allergy and immunology medical billing services cover the coding, claims, denials and payments for allergy testing, immunotherapy, biologic injections and immune disorder care. Prospect Healthcare Solutions handles this full revenue cycle for allergists, immunologists and asthma practices in every state, so your team can focus on patients instead of payer rules.
Allergy claims are billed in units: tests by the number performed, antigen by the number of doses prepared, and biologics by drug units. One wrong count can lose revenue or trigger an audit. We code every service from the record, apply each payer’s rules and follow every claim until it is paid.
Prefer to talk? Call +1 (469) 935-4617.
Why Allergy and Immunology Billing Needs Special Expertise
Allergy practices bill high volumes of small, unit-based services, often several times a week for the same patient. Medicare, Medicaid and commercial plans each define units, doses and visit rules differently, and state Medicaid programs add their own limits.
Common challenges include:
- Billing the right number of test units
- Antigen dose definitions that differ by payer
- E/M visits on the same day as testing or injections
- Prior authorization for biologics
- Drug units and NDCs for office-administered drugs
- Timely filing limits that differ by payer
Allergy and Immunology Payer Rules We Manage
These are the allergy-specific rules our revenue cycle management team checks on every claim:
Allergy test units
What it means: Percutaneous (95004) and intradermal (95024) tests are billed per test, so units must match the number of allergens tested. Interpretation is included and not billed separately.
How we handle it: We match units to the test record and check them against payer limits before the claim goes out.
Antigen preparation doses
What it means: 95165 is billed per dose prepared. Medicare defines a dose as a 1 cc aliquot from a multi-dose vial, while some commercial plans use the dose the patient receives.
How we handle it: We bill doses using each payer’s definition and track vials so units are never over-reported.
Injection codes
What it means: 95115 is billed for one injection and 95117 for two or more on the same day; they are not billed together. Medicare does not accept the complete-service codes 95120–95134.
How we handle it: We choose the injection code from the number given and bill injection and antigen separately for Medicare.
E/M visits on test or injection days
What it means: An E/M visit on the same day as testing or immunotherapy is paid only when it is a significant, separately identifiable service, reported with modifier 25.
How we handle it: We check the note for a separate problem or evaluation before adding an E/M with modifier 25.
Biologics and prior authorization
What it means: Biologics for asthma and allergic disease, such as omalizumab (J2357), are billed in HCPCS units with an NDC and nearly always need prior authorization and reauthorization.
How we handle it: We obtain and track authorizations and bill drug units, NDC and administration (96372) correctly.
Multi-state and Medicaid rules
What it means: State Medicaid programs and regional plans set their own limits on testing, antigen units and visit frequency.
How we handle it: We keep payer rules by state for practices in more than one location and check credentialing with each plan.
Our Complete Allergy and Immunology Billing Services
We manage the full allergy revenue cycle, from patient registration to final payment.
1. Patient Registration and Insurance Verification
We collect accurate patient details and verify eligibility, benefits, copays and prior authorizations before testing, immunotherapy or biologics begin.
2. Allergy and Immunology Coding
Certified coders assign CPT, HCPCS and ICD-10-CM codes for testing, immunotherapy, biologics, spirometry and visits, with units and modifiers checked on every line. See our medical coding services.
3. Clean Claim Submission
Claims are scrubbed for unit, modifier and payer-rule errors before submission, then tracked until paid, with rejections corrected the same day.
4. Denial Management and Appeals
Every allergy denial is worked through a structured process:
- Root cause analysis (units, modifiers, authorization or documentation)
- Corrected claims
- Appeals supported by test records and payer policy
See our denial management services.
5. Patient Billing and Reporting
We send clear patient statements and reminders, answer billing questions, and deliver monthly reports on collections, denials and claim status.
Common Allergy and Immunology Denials and How We Fix Them
Example: an E/M visit denied on an injection day
The denial. A patient receives an allergy injection (95117) and an E/M visit is billed the same day. The E/M is denied with CARC 97 (included in the payment for another service).
How we fix it:
- Review the note. We check whether a separate problem, such as an asthma flare, was evaluated.
- Add modifier 25. If it was, we add 25 to the E/M and resubmit with the note.
- Remove it if not. If the visit only covered the injection, the E/M is not billed.
- Prevent the next one. Injection-day visits are reviewed before billing.
Example: antigen units denied as excessive
The denial. A claim for 95165 is denied or reduced because the units exceed the payer’s limit, often after a commercial dose count is used on a Medicare claim.
How we fix it:
- Check the vial record. We confirm the number of doses prepared.
- Apply the payer’s definition. We recalculate units using that payer’s dose rule.
- Correct or appeal. We resubmit the corrected units, or appeal with the mixing record if the units were right.
Specialized Allergy and Immunology Billing Services
Allergy Testing and Immunotherapy
We bill skin, intradermal, patch and challenge testing, plus antigen preparation and injections, with units matched to your records.
Asthma and Biologic Therapy
We bill spirometry, FeNO testing and biologic injections, with authorizations tracked by patient. See our pulmonary billing services.
Telehealth Allergy Follow-Up
We bill virtual follow-ups with the right place of service and modifiers. See our telehealth billing services.
Allergy and Immunology CPT Codes and Modifiers
These are the allergy and immunology codes we work with most. Unit and coverage rules vary by payer, so we confirm each one before billing.
| Service | Codes | What we check |
|---|---|---|
| Skin and intradermal testing | 95004, 95017, 95018, 95024, 95027 | Units match the number of tests |
| Patch testing | 95044 | Units match the number of patches |
| Ingestion challenge | 95076, 95079 | Test time documented |
| Immunotherapy injections | 95115 (one), 95117 (two or more) | Number of injections given |
| Antigen preparation | 95144, 95165; venom 95145–95149 | Doses prepared; payer dose definition |
| Lung function | 94010, 94060, 95012 (FeNO) | Medical necessity documented |
| Biologic administration | 96372 with J-codes (e.g., J2357 omalizumab) | Units, NDC and prior authorization |
| Same-day E/M | 99202–99215 with modifier 25 | Separate, significant service in the note |
Why Outsource Allergy and Immunology Billing?
Small allergy practices often have one person handling billing, and unit-based coding leaves little room for error. Outsourcing to Prospect Healthcare Solutions gives you:
- Lower operating costs
- Fewer unit and modifier errors
- Faster reimbursement
- Higher collections
- Stronger compliance
Built for Allergy Practices of Every Size
- Dedicated allergy billers
- Certified coders and billers
- HIPAA-compliant processes
- Regular audits and quality checks
- Support for practices in multiple states
Allergy and Immunology Billing Compliance
Unit-based allergy services are a frequent audit target. We follow HIPAA, CMS and payer rules and build compliance into every step:
- Test and dose units supported by records
- Correct modifier 25 use
- Authorizations on file for biologics
- Medical necessity documented for testing
- ABNs signed before non-covered services
Learn about our medical billing audits.
Who We Serve
Our allergy and immunology billing services support practices nationwide:
- Allergists and immunologists
- Asthma and allergy centers
- Pediatric allergy practices
- Clinical immunology and immune deficiency clinics
- Nurse practitioners and physician assistants in allergy care
- Multi-state and multi-location allergy groups
Technology and Reporting for Allergy Billing
We work in your EMR and practice management system and use billing analytics to catch problems early:
- Real-time claim tracking
- Denial trends by payer and code
- Revenue by service (testing, immunotherapy, biologics, visits)
- Secure, HIPAA-compliant data handling
Monthly reports show collections, denials and outstanding AR, so you can plan with confidence.
Allergy and Immunology Medical Billing FAQs
What are allergy and immunology medical billing services?
They cover eligibility checks, coding, claim submission, denial management and payment posting for allergy testing, immunotherapy, biologics, lung function tests and visits.
How are allergy tests billed?
Most allergy tests are billed per test, so the units on the claim must match the number of allergens tested, such as 95004 for percutaneous tests and 95024 for intradermal tests.
What is the difference between 95115 and 95117?
95115 is billed when one allergen immunotherapy injection is given and 95117 when two or more are given on the same day. They are not billed together.
How is antigen preparation (95165) billed?
It is billed per dose prepared. Medicare defines a dose as a 1 cc aliquot from a multi-dose vial; some commercial plans define it differently.
Can an E/M visit be billed on an allergy injection day?
Only when the visit is a significant, separately identifiable service, such as evaluating a new problem, and the E/M is reported with modifier 25.
How do I get a quote for allergy billing?
Request a free billing quote online or call +1 (469) 935-4617. We review your current billing and send a plan and pricing.
Partner with Experts in Allergy and Immunology Medical Billing
Your patients count on you to help them breathe and live more easily. We handle the coding, claims, denials and compliance so your practice gets paid accurately and on time.
Tell us about your practice for a free quote, or call +1 (469) 935-4617.