Allergy & Immunology Billing

Allergy & Immunology Billing Services That Maximize Every Component You Provide

Allergy and immunology billing uses a two-part revenue structure that most billing teams mismanage: allergen immunotherapy serum preparation and injection administration must be billed as separate, distinct services, and the rules governing dose counts, single-dose versus multi-dose vials, and nurse-administered injections are specific enough that errors repeat across every patient visit. Allergy testing code sequencing requires precise dose counting for percutaneous and intradermal tests. ProtoMed's certified allergy billing specialists handle every component correctly. Fewer denials. Faster reimbursements. More revenue.

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Clean Claim Rate

98%+

Clean Claim Rate

We review every claim before submission, catching dose count errors, missed injection add-on codes, allergy testing sequence issues, modifier -25 omissions, and biologics authorization gaps before they trigger denials.

98%+

Clean Claim Rate

< 15 Days

Average A/R Days

Up to 30%

Revenue Increase

100%

HIPAA Compliant

Why Choose Us

Stop Losing Allergy Revenue to Component Billing Errors and Dose Count Mistakes

Allergy and immunology practices generate revenue through a billing model that is unique in outpatient medicine. Allergen immunotherapy involves two separately billable services: the preparation of the allergen serum (billed per dose or per vial) and the administration of the injection (billed per injection visit with add-on codes for each additional injection). These two components must be billed separately, under the correct code, and the dose or vial count must match the physician's prescription exactly. A single miscounted dose on a multi-dose vial claim, or a missed add-on injection code on a multi-allergen visit, represents recurring lost revenue on every affected patient every visit.

Allergy testing adds a second layer of billing precision: percutaneous scratch tests and intradermal tests use different code sets, are billed by the number of tests performed, and payers count tests differently for bundling purposes. When testing and an E/M visit occur on the same day, modifier -25 must be applied correctly. ProtoMed's certified allergy billing team handles every component of immunotherapy billing, testing code sequencing, biologics authorization, and same-day E/M modifier rules, ensuring your practice captures the full reimbursement value of every allergy service provided.

Certified Allergy & Immunology Billing Specialists

Every biller on your account holds active AAPC and AHIMA credentials with hands-on experience in allergen immunotherapy component billing, allergy testing code sequencing, biologics authorization, and payer-specific allergy billing guidelines.

98%+ Clean Claim Rate

Zero-Friction Access

We securely log into your existing EHR and allergy practice management system, with zero disruption to your clinical schedule or injection visit workflow.

End-to-End Claims Management

From eligibility verification and biologics prior authorization to claim submission, denial appeals, and payment posting, we manage your complete allergy and immunology billing cycle.

Proactive Denial Management

Every rejected claim is investigated, corrected, and resubmitted. We recover allergy revenue lost to component billing errors, dose count mismatches, and biologics authorization failures.

Transparent Financial Reporting

Monthly reports and real-time billing data give you a clear picture of your immunotherapy revenue per patient, testing reimbursement rates, biologics revenue, denial patterns, and overall practice financial performance by payer.

Our Expertise

Allergy & Immunology Coding Expertise That Reduces Denials

Allergy and immunology billing spans allergen immunotherapy serum preparation, injection administration, comprehensive allergy testing, biologics infusions, and high-complexity E/M encounters, each with distinct code selection rules, dose-counting requirements, and payer-specific documentation standards. Our certified coders know every code and billing rule across the full allergy service spectrum.

CPT 95144–95165

Allergen immunotherapy serum preparation: single-dose vials and multi-dose vials by dose count

CPT 95115–95117

Allergen injection administration: single injection and two or more injections per visit

CPT 95004–95010

Percutaneous allergy testing: scratch, prick, and puncture tests billed by number performed

CPT 95024–95044

Intradermal allergy testing: sequential and single-dose intradermal tests by count

CPT 95076–95079

Ingestion challenge testing: initial and additional hours with observation billing

J0178 / J2357

Biologics billing: dupilumab, omalizumab, and anti-IL-5 agents with HCPCS drug coding

CPT 99202–99215 + -25

Allergy E/M visits: new and established patients with same-day testing modifier rules

Procedure-Specific Billing

Specialized Billing for Every Allergy & Immunology Service

Each allergy service type carries its own two-component billing rules, dose-counting requirements, or prior authorization standards. ProtoMed's certified team handles every service correctly, capturing the full reimbursement value of every immunotherapy, testing, and biologics encounter your practice provides.

Allergen Immunotherapy Serum Billing

Immunotherapy serum is billed separately from injection administration and must reflect the exact number of doses or vials prepared under the physician's prescription. Single-dose vials (CPT 95144) and multi-dose vials (CPT 95165) use different codes, and multi-dose vial billing requires accurate per-dose counting that matches the prescription. Miscounting doses across a full panel of maintenance patients creates compounding revenue loss. We verify dose counts against physician prescriptions on every serum billing claim and apply the correct single-dose or multi-dose code for every patient.

Allergen Injection Administration Billing

Each injection visit must be billed with CPT 95115 for a single injection and CPT 95117 for two or more injections in the same visit. When a nurse administers injections in the absence of the physician during a maintenance phase, specific documentation and supervision requirements apply. Missed add-on injection codes and incorrect single-versus-multi-injection code selection are the most common billing errors in allergy practices. We accurately bill every injection visit with the correct primary and add-on administration codes and ensure supervision documentation supports each nurse-administered injection claim.

Allergy Testing Billing

Percutaneous allergy tests (CPT 95004–95010) and intradermal tests (CPT 95024–95044) are billed by the number of tests performed, and payers count tests differently for bundling purposes. Many payers cap the number of billable tests per session or apply NCCI edits between test types. When allergy testing and an E/M visit occur on the same day, modifier -25 must be applied to the E/M to protect that revenue. We accurately sequence every allergy test claim, apply payer-specific test count rules, and use modifier -25 correctly on every combined testing and E/M visit.

Biologics Billing & Prior Authorization

Injectable biologics, dupilumab, omalizumab, mepolizumab, and benralizumab, represent the highest-value service line in allergy practice, with individual drug claims often exceeding $1,500–$3,000 per injection. Each requires prior authorization documenting diagnosis criteria, treatment failure history, and step therapy compliance. We manage the complete biologics billing lifecycle from initial authorization and HCPCS drug code billing through ongoing refill authorizations, ensuring uninterrupted biologic therapy and continuous practice revenue.

Subcutaneous & Sublingual Immunotherapy Billing

Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) have distinct billing structures. SCIT involves separate serum preparation and injection administration codes billed at each visit. SLIT involves preparation codes but no injection administration codes, and payer coverage for SLIT varies significantly by plan. We accurately bill every SCIT and SLIT encounter with the correct code set, manage payer-specific SLIT coverage determinations, and capture the full reimbursement value of both immunotherapy modalities.

Same-Day E/M & Testing Visit Billing

Allergy and immunology practices frequently see patients for E/M consultations and testing on the same visit. When testing and E/M services are performed together, modifier -25 must be applied to the E/M code to show it is a separately identifiable service beyond the pre-service work for testing. Without modifier -25, the E/M is automatically denied. We apply modifier -25 correctly on every combined visit, review the documentation to ensure the E/M is clearly supported as a separate service, and bill every allergy consultation and testing visit at its full combined reimbursement value.

Our Process

How ProtoMed's Allergy & Immunology Billing Process Works

A structured four-step process that captures every immunotherapy component, every testing code, and every biologics claim your practice generates, starting from the first patient visit.

Practice Audit & Revenue Gap Analysis

We review your current allergy billing setup, identify revenue leaks from dose count errors, missed injection add-on codes, allergy testing sequence issues, unclaimed modifier -25 revenue, and biologics authorization failures, then securely access your existing EHR and practice management system with zero disruption to your clinical operations.

Eligibility Verification & Biologics Authorization

Before each new patient and biologics order, we verify coverage and benefits, confirm payer-specific testing authorization requirements, and build prior authorization packages for biologics with the diagnosis criteria and step therapy documentation payers require. Proactive biologics authorization management prevents the most costly denials in allergy practice.

Claim Coding, Scrubbing & Payer Submission

Our certified allergy billers review every immunotherapy prescription, verify dose and vial counts, select the correct serum preparation and injection administration codes, apply allergy testing codes by test count and type, bill biologics with correct HCPCS drug codes, and apply modifier -25 on combined E/M and testing visits. Claims are submitted electronically on time to all major payers.

Denial Management, Payment Posting & Reporting

Every denied claim is investigated, corrected, and appealed with the clinical documentation required for reversal, including prescription evidence for dose count disputes and diagnosis documentation for biologics denials. Payments are posted accurately and you receive clear monthly reports on immunotherapy revenue per patient, testing reimbursement rates, biologics collections, and denial patterns.

Ready to Capture the Full Value of Every Allergy & Immunology Service You Provide?

Let ProtoMed's certified allergy and immunology billing specialists handle your complete revenue cycle, from immunotherapy serum preparation and injection administration coding to allergy testing sequencing, biologics authorization, SCIT/SLIT billing, and same-day E/M modifier compliance. We'll audit your current billing, identify where your allergy revenue is being lost to component errors and authorization failures, and start recovering it.

Request Your Free Consultation

Get your free allergy billing audit today. A ProtoMed expert will reach out within 24 hours.

100% HIPAA Compliant AAPC & AHIMA Certified No Long-Term Contracts All 50 States 30+ Specialties