Allergy & Immunology Billing Services

A single allergy visit can combine an evaluation, dozens of skin tests, and an immunotherapy injection, and each piece has its own code, its own unit count, and its own payer rules. That combination is what makes allergy and immunology billing unusually easy to get wrong. Test counts get miscounted, preparation and administration get billed as one service when they are two, and a separate office visit gets added to a testing day without the documentation to support it.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for allergy and immunology practices, built around the specialty’s actual code families and payer requirements.

Allergy & Immunology billing challenges

Allergy testing codes are reported by test type and by number of tests. Percutaneous (skin prick) testing is reported with 95004, intradermal testing with 95024, and patch testing with 95044, with units equal to the number of tests performed. Ingestion challenge testing uses the time-based codes 95076 and 95079, so the documented time, not just the test count, decides the code. Payers also set their own limits on how many tests are covered per session or per year, and exceeding a panel limit without prior authorization is a common denial.
Immunotherapy billing has two separate parts that must stay separate. Antigen preparation is reported with 95165, while administration is reported with 95115 for a single injection or 95117 for two or more injections. The build-up phase and the maintenance phase carry different documentation needs, including lot numbers and dosing schedules, and units must be counted per vial and per visit. Biologic drugs add another layer, with J-codes for the drug itself plus prior authorization requirements that vary by payer.
A separate evaluation and management service on a testing day is only billable when it is significant and separately identifiable from the testing itself. That requires modifier 25 and documentation of a history, exam, and decision making that go beyond interpreting the test results. Billing an office visit for reviewing results or preparing the allergy report alone will not support a separate charge. Custom sublingual immunotherapy drops are another trap: many plans treat them as investigational and map them to an unlisted code, so coverage should be confirmed before the patient starts.

What MedPlus RCM handles for Allergy & Immunology practices

• End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
• Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
• Provider credentialing and enrollment. End-to-end enrollment with commercial payers and Medicare, plus re-credentialing maintenance.
• Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
• A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
• Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
  We serve allergy and immunology practices nationwide, from solo clinics to multi-physician groups, including practices offering skin testing, immunotherapy, and biologic therapy.

Results Allergy & Immunology practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Why is allergy billing more complex than other specialties?
One encounter can combine an office visit, skin testing, intradermal testing, and an injection, each with its own code family and unit rules. Payer panel limits and prior authorization rules add another layer on top of the coding.
Do you bill immunotherapy preparation and administration separately?
Yes. Antigen preparation (95165) and injection administration (95115 or 95117) are separate services with separate codes, and we bill them separately with units counted per vial and per visit.
How do you handle biologic drugs?
Biologics are billed with the applicable J-code for the drug plus the administration code, and we verify prior authorization requirements before the drug is given, since authorization rules vary by payer.
Why did our allergy testing claim deny for medical necessity?
Common causes include missing documentation of the symptoms and history that justified testing, test counts that exceed the payer’s panel limit, and missing prior authorization where the payer requires it.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your allergy and immunology practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit