Home | Allergy & Immunology Billing
Allergy and Immunology Billing: Testing, Shots and Biologics Billed Right
Allergy Testing, Immunotherapy and Breathing Tests
Allergy practices bill many small services that add up: skin tests counted by units, allergen extract doses, injections and breathing tests. Small unit errors can mean big denials or underpayments. Billing Benefit handles allergy and immunology billing so testing, immunotherapy and biologic treatments are coded and paid correctly.
Common Allergy Billing Problems We Fix
| Billing problem | Why it costs you | How we fix it |
|---|---|---|
| Allergy test units wrong | Skin and intradermal tests are billed per test, with payer limits | We count tests from the record and flag yearly limits |
| Antigen doses miscounted | Code 95165 is billed per dose, and Medicare defines a dose as 1 cc | We calculate doses from the vial preparation record |
| Injection codes mixed up | 95115 and 95117 are for injections only, while 95120-95134 include the extract | We match injection codes to who supplied the extract |
| Visit billed on a testing day without support | An office visit on a testing day needs modifier 25 and separate documentation | We bill visits only when the record supports a separate service |
| Biologics without authorization | Biologic drugs for asthma and allergic conditions usually need prior authorization | We get authorizations and bill drugs and administration correctly |
Allergy Codes We Handle
Testing, treatment and breathing tests
We code skin prick testing (95004), intradermal testing (95024, 95027), patch testing (95044), food and drug challenges, allergy shot injections (95115, 95117), antigen preparation (95144-95170), spirometry and bronchodilator testing (94010, 94060), exhaled nitric oxide (95012), biologic injections with administration code 96372, and office visits.
How We Keep Allergy Claims Clean
Unit-level accuracy
We check coverage and testing limits before visits, count tests and doses from your records, and scrub claims for payer edits before they go out. Denials go to our denial management team, and our credentialing services keep your allergists enrolled with each payer.
Payer Rules Allergy Practices Should Watch
Limits on tests and doses
Many payers limit the number of allergy tests per year and the number of antigen doses that can be billed, and Medicare does not recognize the combined injection-and-extract codes. Biologic drugs require prior authorization and regular reauthorization. We track these limits so claims are not denied after the service is given. See how prior authorization delays affect revenue.
Why Allergy Practices Choose Billing Benefit
Billers who know allergy
You get billers familiar with allergy testing and immunotherapy rules, steady follow-up on every claim, and monthly reports by service and payer. Want to see where your practice is losing revenue? Start with a free medical billing audit, or see all the specialties we bill for.
Allergy and Immunology Billing FAQs
How is code 95165 billed?
Code 95165 covers preparing and providing allergen extract and is billed per dose. Medicare counts one dose as 1 cc of extract, so a 10 cc vial is billed as 10 units. Commercial plans may define a dose differently.
What is the difference between 95115 and 95117?
Both are for allergy shot injections without providing the extract. Code 95115 is for a single injection and 95117 is for two or more injections at the same visit.
Can an office visit be billed on an allergy testing day?
Yes, when the provider performs a significant, separately identifiable evaluation. The visit is billed with modifier 25. Interpreting test results is included in the test codes.
Do you bill biologic drugs?
Yes. We handle prior authorization, bill the drug with the right HCPCS code and units, and bill administration with code 96372.
Not Sure Where Your Revenue Is Leaking?
Get a free, no-obligation medical billing audit. We review your claims, denials and A/R, then show you what to fix first.
