Allergy and immunology practices operate a uniquely high-volume coding environment—from percutaneous testing panels to multi-vial antigen preparation and weekly immunotherapy injections. VeriMedix provides specialized A/I billing expertise that captures every testing and treatment code accurately while staying ahead of payer policy changes.
Allergy and immunology (A/I) billing is built around two major service categories: diagnostic allergy testing and allergen immunotherapy (AIT). Percutaneous allergy skin testing uses CPT 95004 (percutaneous tests with allergen extracts, immediate type reaction) billed per test, and 95024 (intracutaneous tests, sequential and incremental for delayed reaction) and 95028 (intracutaneous tests with allergenic extracts, immediate type reaction) for intradermal testing. The number of tests billed must match the number of allergens tested as documented in the test report—overbilling test counts without corresponding documentation is a leading audit trigger. Patch testing for contact dermatitis uses 95044 per application, with 95052 for photopatch tests. Allergy testing billing also encompasses pulmonary function tests (spirometry, 94010–94070), methacholine challenge (95070), bronchial provocation (95071), and food challenge procedures (95076, 95079), which are often performed by A/I practices.
Allergen immunotherapy billing has two components: antigen preparation and injection services. CPT 95165 covers professional services for the preparation of antigen extracts for subcutaneous immunotherapy; it is billed in units, where one unit = one dose of antigen prepared, regardless of the number of allergens in the vial. This is a frequent miscoding area: some practices bill 95165 per allergen rather than per dose, generating overbilling. Injection codes are separate: 95115 covers a single injection of allergenic extract (no supplies included), and 95117 covers two or more injections. The injection codes are intended to cover the injection service only—they may be billed each visit by the administering physician regardless of whether the serum was provided by an outside allergist. CPT 95120–95134 are used for combined allergen preparation and injection services (when the same physician both prepares and injects). Allergy practices must carefully track injection visit frequency, vial fill dates, and the distinction between physician-prepared vs. patient-supplied serum to avoid billing errors.
A growing revenue stream in A/I practices is biologic injectable therapy for severe asthma, atopic dermatitis, chronic urticaria, and eosinophilic conditions. Drugs such as dupilumab (J0222), omalizumab (J2357), mepolizumab (J2182), benralizumab (J0517), and tezepelumab (J0222 is dupilumab—tezepelumab is J3245) each have specific HCPCS J-codes, require prior authorization, and must comply with NDC and JW/JZ reporting for Medicare. The administration of these injectable biologics is billed using 96372 (subcutaneous injection) or 96401/96402 as appropriate, with modifier -25 on the accompanying E/M if separately identifiable. IVIG administration for primary immunodeficiency (PID) patients (J1459, J1569 series for subcutaneous IVIG alternatives such as J1558 immune globulin hizentra) is also a significant service line requiring OPAT-level documentation and prior authorization.
Below are commonly billed codes our certified coders manage for allergy and immunology practices. Always confirm payer-specific coverage and current code values.
| Code | Description | Billing note |
|---|---|---|
95004 | Percutaneous tests with allergenic extracts, immediate type reaction; specify number of tests | Bill per individual allergen tested; number billed must match test documentation; most common allergy testing code |
95165 | Professional services for allergen immunotherapy not including provision of allergen extract; single or multiple antigens, per dose | Bill per dose prepared, not per allergen; one of the most frequently miscoded A/I codes |
95115 | Professional services for allergen immunotherapy; single injection | Injection-only code (no preparation included); used when injecting serum prepared by another provider |
95117 | Professional services for allergen immunotherapy; two or more injections | Used when two or more separate injections given in same visit (e.g., two arms); not per allergen—per visit with multiple injections |
95120 | Professional services for allergen immunotherapy in prescribing physician's office or institution; single injection (includes antigen) | Used when the same physician prepares AND injects; replaces 95165 + 95115 combination |
95044 | Patch or application tests | Contact dermatitis testing; bill per patch; typically 20–80 patches applied at once |
94010 | Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s) | Pulmonary function test commonly performed in A/I offices; requires CLIA certification for lab component |
J2357 | Injection, omalizumab (Xolair), 5 mg | Anti-IgE biologic for severe allergic asthma and chronic idiopathic urticaria; prior auth required; NDC and JW/JZ for Medicare |
J2182 | Injection, mepolizumab (Nucala), 1 mg | Anti-IL-5 biologic for severe eosinophilic asthma; prior auth; document eosinophil count in PA submission |
Our standard operating procedures for allergy and immunology revenue cycle management — the step-by-step workflow we follow on every claim:
These are the issues we see most often in allergy and immunology billing — and exactly how we resolve them:
Billing 95165 per allergen (e.g., 30 units for a 30-allergen mix in one vial) instead of per dose (typically 1–2 doses prepared per session) results in significant overbilling, which is an OIG audit target. Fix: Train all billing and clinical staff that 95165 = per dose prepared, not per allergen; conduct a full audit of historical 95165 billing to identify and correct systematic miscoding.
Billing 50 units of 95004 when the documented test report shows only 40 allergens tested creates a claim discrepancy that triggers payer audit and potential recoupment. Fix: Reconcile billed test count with the signed allergy test report at charge entry; configure the billing system to pull the test count directly from the allergy testing module or require a signed count attestation.
Biologics for asthma and atopic dermatitis require PA that specifies the drug, dose, frequency, and sometimes step-therapy documentation (e.g., prior ICS/LABA failure for mepolizumab). Administering before PA approval results in non-covered service denials. Fix: Implement a biologic authorization workflow with a dedicated PA coordinator; never schedule biologic injections until PA is confirmed in writing; track renewal dates 30 days in advance.
Payers routinely bundle the E/M into the allergy testing service when both are billed on the same date without modifier -25, reducing reimbursement. Fix: Apply -25 to the E/M whenever allergy testing or immunotherapy is also performed; document that the E/M addressed a separately identifiable clinical decision beyond what is inherent to the testing service.
Omalizumab, dupilumab, and mepolizumab are single-dose vials requiring NDC reporting on Medicare and many commercial claims. Omitting NDC causes claim rejection or denial. Fix: Integrate NDC capture into the injection room workflow; require nurses to record NDC from the vial on the encounter form or in the EHR injection module before billing is generated.
Verimedix works inside the systems allergy and immunology practices already use, including:
Yes. CPT 95115 and 95117 are injection-only codes—they do not include antigen preparation. Use these codes when the patient brings their own serum prepared by another allergist. CPT 95120–95134 are used when the same physician or practice both prepares and administers the antigen. Clarify the preparation source on each injection encounter to select the correct code family.
There is no universal CMS limit on the number of skin tests per session, but tests billed must match the number documented in the allergy test report. Many payers apply coverage limitations (e.g., 80 percutaneous tests per year) via LCD policies. Always document the full test result form with allergen name, test result, and patient response for every test billed.
Yes, if it is a distinct service with a separate clinical indication. Bill 94010 (spirometry) with modifier -59 if needed to distinguish from the E/M. Append modifier -25 to the E/M. The practice must have the appropriate CLIA waiver or certification for pulmonary function testing if the technical component is billed.
CPT 95076 covers supervised food challenge testing up to the first 120 minutes; 95079 covers each additional 60 minutes. These procedures require a physician supervising the challenge, nursing monitoring, and an emergency protocol. Document time, food administered, doses, and any reactions. Some payers require a specific medical necessity criteria met before covering oral food challenges.
Required elements typically include: confirmed diagnosis of moderate-to-severe persistent allergic asthma or chronic idiopathic urticaria, elevated serum IgE level (for asthma indication), positive skin test or RAST to perennial allergen, documentation of prior controller medication use, and clinical notes supporting inadequate control. For chronic urticaria, document failed antihistamine therapy at maximum dose. Submit lab results and specialist notes with PA.
Bill 96365/96366 for the IV infusion administration service, and the appropriate IVIG J-code (J1459 for carimune, J1569 for gammagard liquid; product-specific codes apply) for the drug. NDC reporting and JW/JZ modifiers are required on Medicare. Prior authorization is required by most payers and typically requires documentation of confirmed PID diagnosis (ICD-10 D80–D84 series) and immunoglobulin level below normal range.
Verimedix handles the entire allergy and immunology revenue cycle — coding, submission, denials, and A/R — so your team can focus on patients.