Allergy & Immunology Revenue Infrastructure
Medbilling RCM provides specialized immunology billing services covering allergy testing (CPT 95004-95078), allergen immunotherapy administration (CPT 95115-95199), biologic infusion therapy (HCPCS J-codes), IVIG billing, and prior authorization management, ensuring accurate claims and maximum reimbursements for allergy and immunology practices.
Biologic & J-Code Expertise
Biologic therapies require HCPCS J-codes for the drug plus CPT administration codes plus prior authorization, all managed simultaneously. Our team handles the complete biologic billing cycle for every approved drug in your formulary.
Core Allergy Billing Services
Allergy and immunology billing spans percutaneous testing, intradermal testing, antigen preparation, and immunotherapy administration, each with specific CPT codes, unit billing rules, and CCI edits that determine correct reimbursement.
Percutaneous tests (95004), intradermal tests (95024), and patch tests (95044) are billed per test with unit reporting. Maximum tests per visit vary by payer. We verify payer-specific test limits, apply correct CPT codes based on test type, and ensure per-unit billing accuracy on every testing claim.
Immunotherapy injection CPT 95115 (single injection) and 95117 (two or more injections) report administration. Antigen preparation (CPT 95165) reports provision of allergen extracts. Both services are billed together when the practice provides full service. Allergy testing and immunotherapy are generally not billed on the same date without specific documentation of additional allergens.
Biologic administration requires both a HCPCS J-code for the drug and an infusion CPT code for administration. IV infusion therapy uses CPT 96365 (first hour) and 96366 (additional hours). Subcutaneous biologics use CPT 96401. We manage J-code selection, dose unit billing, waste billing where applicable, and concurrent infusion rules.
IVIG is billed using J1459 (or brand-specific J-codes) for the drug product plus infusion administration codes. IVIG requires prior authorization with documentation of specific indications (CVID, ITP, Guillain-Barré). We manage IVIG authorization, dosing documentation, infusion time tracking, and payer-specific coverage rules.
Biologic prior authorizations require failed step therapy documentation, diagnostic test results, and severity scoring. Immunotherapy plans require positive skin test results and failed avoidance documentation. We manage every authorization with complete clinical packages, renewal tracking, and peer-to-peer coordination.
Modifier 25 is required when a significant E/M service is performed on the same date as allergy testing or immunotherapy injection. We apply Modifier 25 only when documentation supports a distinct, separately identifiable evaluation, protecting compliance while capturing earned revenue.
Revenue Control Framework
End-to-end allergy and immunology billing infrastructure, from insurance verification and biologic prior authorization through J-code submission and denial management.
Confirm allergy testing coverage, immunotherapy benefits, biologic formulary, infusion site requirements, and prior authorization requirements before every service
Submit complete authorization packages for biologics (failed step therapy, severity scores, diagnostic results) and immunotherapy plans (skin test results, avoidance failure)
AAPC-certified coders assign allergy testing CPT codes (95004-95078), immunotherapy codes (95115-95199), J-codes for biologics, and infusion administration codes (96365-96368)
Verify CCI edit compliance for same-day testing and immunotherapy, apply Modifier 25 for qualifying E/M services, and check unit billing accuracy on all per-test and per-dose claims
Clean claims submitted electronically with ICD-10 specificity verified, J-code drug quantities confirmed, and medical necessity linked before every submission
Root-cause denial analysis, authorization appeals, peer-to-peer coordination support, and systematic AR follow-up on all outstanding immunology claims
Operational Transformation
Why Medbilling RCM
Our immunology billing team understands allergy testing unit billing, immunotherapy CPT codes, biologic J-code pairing, IVIG authorization requirements, and the CCI bundling rules that govern same-day testing and treatment encounters.
Every FDA-approved biologic billed with correct J-code, dose unit calculation, and concurrent infusion rules, including omalizumab, dupilumab, mepolizumab, and IVIG.
Per-test unit reporting for CPT 95004-95078 with payer-specific test limit compliance and CCI edit verification on every testing claim.
95115/95117 (injection) + 95165 (antigen preparation), both components billed correctly when the practice provides complete service.
Complete authorization packages with failed step therapy documentation, diagnostic results, and severity scoring for all biologic treatments.
Every specialist holds AAPC certification with dedicated allergy and immunology training. CMS and AMA guidelines applied on every claim.
Modifier 25 applied only when documentation supports a distinct E/M, protecting compliance while capturing earned revenue on same-day encounters.
Complete IVIG billing: J1459/brand J-codes, infusion time tracking, 96365/96366 coding, waste billing, and prior authorization support.
Service-level revenue reports, biologic authorization tracking, denial trend analysis, and AR aging by procedure and payer.
Common Questions
Direct answers about allergy testing billing, immunotherapy coding, biologic J-codes, prior authorization, and Modifier 25. View all specialties we serve.
CPT codes for allergy testing (95004-95078) and immunotherapy (95115-95199) are generally not reported on the same date of service unless the physician provides allergy immunotherapy and testing for additional allergens on the same day. Allergen potency testing prior to immunotherapy administration is an inherent component of immunotherapy and is not separately reportable. We verify CCI edits and payer-specific rules before billing both services on the same date to prevent bundling denials.
Biologic drugs administered in-office require HCPCS J-codes for the drug (J2357 for omalizumab, J3385 for dupilumab) plus infusion administration CPT codes (96365-96368 for IV infusion, 96401 for subcutaneous injection). Prior authorization is required for most biologics with clinical documentation of failed step therapy. We manage the complete biologic billing cycle: prior authorization, J-code selection, administration coding, and copay assistance program coordination.
Modifier 25 is required when a significant, separately identifiable E/M service is performed on the same date as allergy testing or immunotherapy injection. Without Modifier 25, payers bundle the E/M into the procedure fee. We apply Modifier 25 only when documentation supports a distinct, separately identifiable evaluation, protecting compliance while capturing earned revenue on every qualifying encounter.
Allergen immunotherapy plans require documentation of positive skin test results, failed avoidance measures, and physician-documented treatment rationale. Biologic therapies require failed step therapy documentation (typically failed antihistamines and inhaled corticosteroids), diagnostic test results, and severity scoring. We submit complete authorization packages, track renewal timelines, manage peer-to-peer coordination, and maintain payer-specific authorization requirements for all immunotherapy and biologic treatments.
Common immunology ICD-10 codes include J30.1 (allergic rhinitis due to pollen), J30.9 (unspecified allergic rhinitis), J45.909 (unspecified asthma uncomplicated), L20.9 (atopic dermatitis unspecified), D83.9 (common variable immunodeficiency), L50.0 (allergic urticaria), and T78.40XA (allergy, unspecified, initial encounter). We select the most specific ICD-10 code for every encounter and link testing and treatment codes to diagnoses that satisfy payer medical necessity criteria.
Revenue Assessment
Schedule a free immunology billing assessment and discover how accurate biologic J-code billing, allergy testing unit coding, and prior authorization management can significantly improve your practice collections.
