(479) 552-5346
|
info@paramedbilling.com
|
Northgate Drive, Sherwood, AR 72120, USA
(479) 552-5346
ParaMed Billing Solutions - Navigation
Make Payment
(479) 552-5346 Talk To An Expert Today

Allergy & Immunology Billing

Allergy & Immunology Billing | ParaMed Billing Solutions
HomeSpecialtiesAllergy & Immunology Billing
Allergy & Immunology Specialty Billing

Allergy Billing Requires
Precision at Every Dose.Testing. Immunotherapy. Biologics. Every Code Matters.

Allergy & Immunology billing is one of the most technically demanding specialties in all of medicine. You bill for allergy testing by method, number, and allergen category. You bill for immunotherapy by formulation type, administration route, and dose stage. You manage prior authorization for six different biologic drugs — each with distinct step therapy requirements, diagnosis criteria, and payer-specific protocols. Without a billing team that knows A&I inside out, you lose money on every test panel, every injection visit, and every biologic administration. ParaMed's A&I-certified billing specialists know every rule in every category — and keep your revenue cycle as precise as your clinical protocols.

98%
Clean Claim Rate
+27%
Revenue Lift
<3.5%
Denial Rate
100%
Bio PA Tracking
🌳
Tree Pollen
95004 / 95024
🌾
Grass & Weed
95004 / 95017
🐱
Animal Dander
95004 / 95024
🦟
Insect Venom
95145–95149
🍤
Food Allergy
95004 / 86001
💊
Drug Allergy
95004 / 95076
🧫
Mold & Fungi
95004 / 95024
Four Billing Domains

Allergy & Immunology Billing Operates Across Four Completely Distinct Revenue Categories

Each category has its own CPT code family, its own documentation requirements, and its own compliance rules. ParaMed manages all four — at specialty-certified precision.

Allergy Testing Billing

Percutaneous · Intradermal · In Vitro · Challenge
01

Allergy testing billing is unit-based — you bill per test, per method, and within strict unit limits that vary by test type. Percutaneous skin prick tests (95004), intradermal tests (95024/95028), patch tests (95044), and in-vitro serum testing (86003/86001) each have different per-unit reimbursement, different maximum billable units per session, and different documentation requirements. The critical skill is knowing the NCCI edit rules, the documentation standard for each test type, and the payer-specific maximum units — and applying all three correctly on every testing encounter.

Unit-based billing — correct count on every test panel is essential
NCCI edits prohibit same-day billing of certain test type combinations
Payer-specific maximum units per session vary widely
Reading and interpretation code separate from application code
In vitro serum testing uses lab-specific code families
950049502495028950448600395076

Allergen Immunotherapy

SCIT · SLIT · Venom · Preparation + Administration
02

Immunotherapy billing requires understanding the separation between allergen preparation (the professional service of formulating the extract) and allergen administration (the injection service). Both are billable, often by different providers. SCIT bills for extract preparation by stinging insect (95145–95149) or inhalant allergen (95165) and administration codes (95115, 95117) per injection visit. The build-up vs. maintenance phase distinction matters for both documentation and medical necessity. Each component must be correctly separated, attributed to the right provider, and billed with the correct units and modifiers.

Preparation and administration — two separate billable components
Build-up vs. maintenance phase — different frequency and billing rules
Venom immunotherapy uses separate code families per insect species
SLIT vs. SCIT — different code families, different documentation
Split-billing when preparation and administration by different providers
951159511795120951459516595180

Biologic Drug Billing

Dupilumab · Omalizumab · Mepolizumab · Benralizumab
03

Biologics administered in the allergy office represent some of the highest-value claims in the specialty — and the most PA-intensive. Omalizumab (Xolair, J2357), dupilumab (Dupixent, J0223), mepolizumab (Nucala, J2182), benralizumab (Fasenra, J0517), tezepelumab (Tezspire, J3241) each require specific J-code billing with NDC documentation, dose-accurate quantity units, administration code billing (96372), and a prior authorization process that varies by drug, by indication, and by payer. Missing any component costs hundreds to thousands of dollars per visit.

J-code + NDC documentation required for every biologic claim
Dose-accurate unit count — dosing varies by weight and indication
96372 administration code separately billable in non-facility settings
PA management — each drug has distinct payer-specific criteria
Step therapy requirements must be documented pre-PA submission
J2357J0223J2182J0517J324196372

Asthma & Immune Deficiency

Spirometry · IVIG · Immunodeficiency Management
04

Asthma management includes pulmonary function testing billing (spirometry 94010, pre/post-bronchodilator 94060, methacholine challenge 94070) and E/M coding at appropriate complexity levels. Immune deficiency billing covers IVIG administration (90284 + J-codes for IVIG products), SCIG subcutaneous immunoglobulin (J1559/J1561), and the complex prior authorization management for immunoglobulin products. Each immunoglobulin product has a specific J-code, dose-based unit calculation, and PA criteria. In-office administration vs. home infusion billing have completely different rules.

Spirometry pre/post bronchodilator — two separate billable events
IVIG J-codes specific to product — J1566/J1557/J1561 by brand
SCIG administration (96369/96371) vs. IVIG (96365/96367) — different codes
Immune deficiency diagnosis codes required for Ig PA
Facility vs. non-facility IVIG billing — completely different rules
94010940609028496365J1566J1559
Revenue Leak Analysis

7 Revenue Failures in Your A&I Practice Right Now

These are the billing failures we find in virtually every allergy & immunology practice operating with generalist billing. Each one is measurable, preventable, and compounding every week.

$40–$120/visit
Average lost per allergy testing encounter from unit undercounting
91% of practices
With biologics programs have active PA management gaps
$200–$2,400+
Lost per biologic administration from J-code or PA documentation failure
+27% avg
Revenue increase per A&I practice after ParaMed onboarding
01

Allergy Test Unit Undercounting — Leaving Money on Every Testing Panel

Allergy skin testing is billed per unit. When billing teams enter a flat CPT code without accurately counting the number of allergens tested, you receive reimbursement for one unit when you've performed 40, 60, or 80 units. The difference between billing 95004 x 1 and 95004 x 60 is the entire revenue value of the test. Unit accuracy on testing encounters is the single most impactful billing correction for most allergy practices.

$40–$120Lost per testing encounter from unit errors
02

Immunotherapy Preparation vs. Administration — Billing Only One Component

SCIT billing has two separately billable components: the allergen preparation service (95165 for inhalant, 95145–95149 for venom) and the allergen injection administration (95115, 95117). Many generalist billing teams know to bill for the injection administration but don't understand that the extract preparation is a separately billable professional service. Missing the preparation component is a persistent revenue gap that compounds with every immunotherapy patient on your panel.

50% revenueLost when preparation component omitted from SCIT billing
03

Biologic J-Code Errors — Wrong Code, Wrong Dose, Wrong Units

Each biologic drug has a specific J-code, and the unit count reflects a specific dose increment. Omalizumab (J2357) is billed per 5mg — a 300mg dose requires 60 units. Dupilumab (J0223) is billed per 1mg — a 300mg dose requires 300 units. When billing teams enter the wrong J-code or unit count, the claim either denies, reimburses at the wrong level, or triggers a compliance audit. For drugs that reimburse at $800–$3,000+ per dose, a unit calculation error can cost hundreds to thousands of dollars.

$200–$2,400+Per biologic dose from J-code or unit calculation error
04

Biologic Prior Authorization Lapses — Revenue Lost to Administrative Failure

Every biologic used in allergy requires prior authorization from virtually every commercial payer and Medicare Advantage plan. Each PA has an expiration date; most require annual renewal. When a biologic is administered without an active, valid PA, the entire claim denies. For a drug that costs $800–$3,000+ per administration with 4-8 administrations per year, a single PA lapse can represent $3,200–$24,000 in revenue placed at risk.

$3,200–$24K/yrAt risk per biologic patient without active PA tracking
05

Patch Testing — Incorrect Antigen Count and Interpretation Billing

Patch testing (95044) is billed per antigen — a standard panel with 36 antigens is coded as 95044 x 36. Reading patch tests requires two separate professional readings at different time intervals — and each reading encounter is separately billable as an office visit. Many practices bill a flat single unit instead of per-antigen units, or fail to bill both readings, systematically losing significant revenue on a service that supports full billing.

70–80% reductionIn patch test revenue from flat-unit billing instead of per-antigen count
06

Same-Day Test + E/M — Missing Modifier -25 Documentation

When an allergy evaluation (E/M service) and testing are performed on the same day by the same provider, the E/M is separately billable — but only with Modifier -25 indicating it was a significant, separately identifiable service beyond the pre-test assessment. Without Modifier -25 with supporting documentation, the E/M is bundled into the testing encounter under NCCI and denied.

E/M denialOn every same-day test visit without documented Modifier -25 justification
07

Spirometry and PFT Billing — Incomplete Component Billing

Pulmonary function testing has multiple separately billable components: the spirometry (94010 or 94060 for pre/post bronchodilator, which includes both measurements), the flow-volume loop (94375), and bronchodilator administration (J7613 for albuterol). When only the base spirometry code is billed without the pre/post bronchodilator component or without the bronchodilator administration, revenue is systematically missed on a frequently performed service.

$45–$90Per PFT encounter from incomplete pre/post bronchodilator component billing
Immunotherapy Billing Intelligence

The Build-Up → Maintenance Billing Journey — Every Phase Explained

Allergen immunotherapy billing follows the clinical protocol — and the billing rules change at each phase of treatment. Understanding which codes apply in build-up vs. cluster vs. maintenance, and how to correctly separate preparation from administration, is essential to capturing full immunotherapy revenue.

Immunotherapy Phase Billing Tracker

Billing rules, CPT codes, and documentation requirements by treatment phase

Phase 1

Initial Build-Up Phase

Weekly injections increasing from low to high dose over 3–7 months. Each visit: administration code (95115 or 95117) + preparation component separately billed by allergist.

95115 Single injection
95117 2+ injections
95165 Preparation (per dose)
Phase 2

Cluster & Rush Protocols

Multiple injections per visit on multiple days — rapid build-up. Each injection on each day is separately billable with 95117 (2+ injections). Pre-medication administered in-office is separately billable when physician-administered.

95117 Multiple per day
99213 E/M if separate
J1200 Diphenhydramine admin
Phase 3

Maintenance Phase

Monthly injections at maintenance dose indefinitely. Preparation code billing (95165) continues. Documentation of maintenance dose and clinical response required at each visit.

95115 Monthly injection
95165 Ongoing prep
99213 Annual review E/M
Phase 4

Venom Immunotherapy

Stinging insect venom immunotherapy uses entirely separate codes from inhalant SCIT. Preparation codes 95145–95149 vary by number of insect species in the formulation. Same administration codes apply.

95145 1 venom species prep
95149 5 venom species prep
95115 Administration

Subcutaneous Immunotherapy (SCIT)

Injection-based — highest reimbursement, most complex billing

Extract Preparation — Allergist Professional Component

95165 (inhalant, per dose) or 95145–95149 (venom, per species) — the allergist's professional work in formulating and maintaining the antigen extract. Separately billable from the injection administration.

95165 / 95145–95149
Administration — Per Visit (1 or 2+ Injections)

95115 for a single injection visit, 95117 when 2 or more injections are administered in the same visit. Both codes bill the complete injection service including the 30-minute observation period.

95115 / 95117
Anaphylaxis Risk — Observation Period Billing

Post-injection observation is clinically required (30 minutes standard) and included in the administration code — do not separately bill for observation. If an anaphylactic reaction occurs requiring treatment, emergency management is separately billable.

99211 for injection supervision if NP/PA administers
Split-Billing — Preparation by Allergist, Administration by Nurse

When the allergist prepares the extract but a nurse or MA administers the injection, the preparation is billed under the allergist, and the administration may require specific billing handling based on the supervision level and setting.

Modifier rules apply for split-billing

Sublingual Immunotherapy (SLIT)

Drop/tablet-based — different billing pathway, growing utilization

FDA-Approved SLIT Tablets — CPT and HCPCS Codes

FDA-approved sublingual immunotherapy tablets (Grastek, Ragwitek, Odactra) have specific HCPCS codes. Coverage by commercial payers is inconsistent — many require PA and some don't cover SLIT at all.

J3490 / specific HCPCS per product
Compounded SLIT Drops — Coverage Challenges

Compounded sublingual immunotherapy drops are not FDA-approved and are not covered by Medicare or most commercial payers. Practices offering compounded SLIT must have a clear patient financial responsibility policy.

Patient-pay — no insurance billing
SLIT Prescribing — E/M at Prescription Visit

The E/M visit at which SLIT is prescribed and therapy is initiated is fully billable as a standard office visit. Follow-up visits for SLIT therapy monitoring are also separately billable E/M services.

99213–99215 + SLIT product code
Documentation — Medical Necessity for SLIT Coverage

For payers that do cover FDA-approved SLIT tablets, coverage requires documentation of the specific allergen sensitivity, prior treatment history, and the clinical rationale for SLIT over SCIT.

PA required by most payers for SLIT tablets
CPT Code Deep Dive

Allergy & Immunology Billing — By Service Category

Select any billing category to explore specific CPT codes, reimbursement benchmarks, and the billing rules that determine whether your claims are paid at maximum defensible value or quietly denied.

Allergy Testing

Skin prick, intradermal, in vitro

Immunotherapy

SCIT, SLIT, venom

Biologic Drugs

Omalizumab, dupilumab, more

Asthma & PFT

Spirometry, challenge, IVIG

Allergy Testing CPT Codes

Allergy Testing — Unit-Based Billing Requires Precision at Every Panel

Every allergy test type has a different CPT code and a different unit-counting rule. The unit count on every testing claim must match the exact number of tests performed in each category — and must comply with NCCI same-day combination restrictions.

95004
Percutaneous Skin Tests — Per Test

Prick or scratch method, per allergen tested. A 60-allergen panel = 95004 x 60. Must list allergens tested with results for each.

~$3.50–$5 per unit billed
95024
Intradermal Tests — Per Test (w/o Re-test)

Intradermal allergy skin testing, without re-test. Higher reimbursement per unit than percutaneous but strict unit limits apply per session per payer.

~$8–$12 per unit billed
95044
Patch Tests — Per Antigen

Contact allergy patch testing, billed per antigen applied. Standard T.R.U.E. TEST = 36 antigens = 95044 x 36. Requires two timed readings.

~$3–$4.50 per antigen unit
86003
IgE Allergen-Specific — Per Allergen (In Vitro)

Serum IgE testing for specific allergen sensitivity — lab-based. Each allergen tested = one unit. Must be correctly attributed when ordered and interpreted by the allergist in the office.

~$18–$28 per allergen tested
95076
Ingestion Challenge Test — 120 Minutes

Oral food or drug challenge test, first 120 minutes of monitoring. 95079 is each additional 60 minutes. Requires documentation of challenge protocol, observed reactions, and clinical outcome.

~$185–$260 first 2 hours
95028
Intradermal w/ Re-test — Delayed Type

Intradermal testing with re-test for delayed hypersensitivity reaction — two readings required. Both 15-minute and 4–8 hour readings must be documented.

~$12–$18 per allergen unit

Critical Testing Billing Rules

Count Every Unit — 1 Test = 1 Unit, Every Time

The unit count on 95004 or 95024 must equal the exact number of individual allergens tested. A 60-allergen panel is 95004 x 60, not 95004 x 1. Unit errors are the single most common and most costly allergy testing billing mistake.

NCCI: 95004 and 95024 on Same Day — Specific Rules

Percutaneous (95004) and intradermal (95024/95028) tests may be billed on the same day when medically necessary — but specific NCCI rules apply. Documentation must support the medical necessity of performing both test methods.

Modifier -25 for E/M + Testing Same Day

When an allergy evaluation and testing are on the same day, the E/M requires Modifier -25 and documentation that the evaluation addressed a clinical decision beyond the testing order. Without -25, the E/M is bundled and denied.

Immunotherapy CPT Codes

Allergen Immunotherapy — Preparation + Administration = Both Billable

The most important rule in immunotherapy billing: there are two separately billable services — allergen preparation and allergen administration. Both must be identified, correctly coded, and submitted. Missing either component writes off half or more of your immunotherapy revenue.

95115
Immunotherapy Injection — Single Injection Visit

Administration of a single allergen injection per visit. Includes the 30-minute post-injection observation period. Billed per visit, not per injection when only one extract is administered.

~$22–$36 per single injection visit
95117
Immunotherapy Injection — 2 or More Extracts Per Visit

Administration of two or more allergen injections per visit. A patient receiving separate left-arm and right-arm injections = 95117, not two 95115 codes.

~$32–$48 per multi-injection visit
95165
Inhalant Allergen Preparation — Per Dose

The allergist's professional service of preparing and maintaining the allergen extract — per dose. The most frequently missed immunotherapy billing component. Separately billable from the injection administration.

~$6–$10 per dose unit prepared
95145
Venom Immunotherapy Preparation — Single Stinging Insect

Extract preparation for a single stinging insect venom species. 95145 (1 species) through 95149 (5 species). Significantly higher reimbursement per dose than inhalant SCIT preparation.

~$32–$55 per venom preparation dose
95180
Rapid Desensitization — First Hour (Drug Allergy)

Rapid desensitization protocol for drug allergy — per hour. First hour: 95180; each additional hour: 95199. High-intensity monitoring service with distinct documentation requirements.

~$280–$420 first hour
95120
Stinging Insect Venom — Professional Service Only

Venom immunotherapy — professional service component only (no supply). Used when the physician provides professional management services for venom immunotherapy being administered at another facility.

~$30–$48 professional service only

Critical Immunotherapy Billing Rules

Always Bill Both: Preparation AND Administration

95165/95145-95149 (preparation) and 95115/95117 (administration) are both separately billable. Never omit the preparation component — it represents a significant share of total immunotherapy revenue.

95117 vs. Two 95115 — One Code, Not Two

When two injections are given in one visit, bill 95117 once — not 95115 twice. NCCI edit rules prohibit two 95115 codes on the same date of service for the same patient.

Build-Up Phase Frequency — Document Dose at Every Visit

During build-up, the increasing dose at each visit should be documented — both for clinical reasons and to support the continued medical necessity of the increasing-dose protocol.

Biologic Drug CPT Codes

Biologic Drugs — J-Code Precision + PA Management = Maximum Revenue Capture

Each biologic used in allergy has a specific J-code billed per dose-accurate unit, requires NDC documentation, must have active prior authorization, and must be accompanied by a separately billed administration code. All five requirements must be met on every biologic claim.

J2357
Omalizumab (Xolair) — Per 5mg

Anti-IgE monoclonal antibody for moderate-severe allergic asthma and chronic idiopathic urticaria. 300mg dose = 60 units. Weight/IgE-based dosing table documentation required.

~$900–$2,800 per dose (dose-dependent)
J0223
Dupilumab (Dupixent) — Per 1mg

IL-4/IL-13 antagonist for atopic dermatitis, asthma, CRSwNP, and eosinophilic esophagitis. 300mg dose = 300 units. High PA burden with indication-specific criteria.

~$1,800–$3,600 per dose
J2182
Mepolizumab (Nucala) — Per 1mg

Anti-IL-5 for severe eosinophilic asthma. 100mg subcutaneous every 4 weeks. Bill as J2182 x 100 units. Different PA processes for asthma vs. EGPA indication.

~$2,600–$3,200 per 100mg dose
J0517
Benralizumab (Fasenra) — Per 1mg

Anti-IL-5Rα for severe eosinophilic asthma. 30mg subcutaneous — every 4 weeks for first 3 doses, then every 8 weeks. Bill as J0517 x 30.

~$3,400–$4,200 per 30mg dose
J3241
Tezepelumab (Tezspire) — Per 1mg

Anti-TSLP for severe uncontrolled asthma regardless of eosinophil count. 210mg subcutaneous every 4 weeks. NDC documentation critical as code is relatively new.

~$3,200–$4,000 per 210mg dose
96372
Subcutaneous/IM Injection — Administration Code

Billed separately from the J-code for every biologic administered in a non-facility setting. The J-code covers the drug; 96372 covers the professional administration service. Both must appear on every biologic claim.

~$22–$38 administration component

Critical Biologic Billing Rules

Calculate Units Precisely — Dose ÷ Unit Increment = Units to Bill

J2357 (omalizumab) = per 5mg, so 300mg ÷ 5mg = 60 units. J0223 (dupilumab) = per 1mg, so 300mg = 300 units. Every biologic has a different unit calculation — errors mean under-payment or audit exposure.

NDC Documentation Required for Every J-Code

The National Drug Code (NDC) from the specific lot/package administered must be documented with every J-code claim. Missing NDC documentation is a direct cause of biologic drug claim denials.

Active PA Before Every Administration — Track Expiration Dates

Every biologic requires active, valid PA before administration. Track PA expiration dates and submit renewal requests 4–6 weeks before expiration. Administering without active PA results in full claim denial.

Asthma & PFT Billing

Pulmonary Function Testing & Asthma Management — Multiple Billable Components Per Encounter

PFT performed in the allergy office generates multiple separately billable components depending on the tests performed and whether pre/post bronchodilator measurements are included. Identifying and billing every component on every PFT encounter is the key to capturing full asthma service revenue.

94010
Spirometry — Measurement of Respiratory Flow

Spirometry with graphic record, without bronchodilator. NOT billable when pre/post bronchodilator is performed — 94060 replaces 94010 when pre/post is done.

~$52–$76 spirometry only
94060
Spirometry — Pre and Post Bronchodilator Measurement

Spirometry performed before AND after bronchodilator administration. Includes both measurements in one code — do NOT bill 94010 in addition to 94060. Bronchodilator administration (J7613) separately billable.

~$92–$136 pre/post spirometry
94070
Bronchospasm Provocation — Methacholine Challenge

Methacholine or other bronchospasm provocation testing with multiple spirometric determinations. Requires documentation of baseline spirometry, methacholine doses administered, and clinical interpretation.

~$220–$340 methacholine challenge
96365
IVIG Infusion — Initial Infusion Up to 1 Hour

IV infusion of immunoglobulin — first hour. 96366 for each additional hour. The immunoglobulin J-code (J1566/J1557/J1561 by product) is billed separately.

~$118–$160 first infusion hour
J1566
IVIG — Gamunex-C/Gammaked Per 500mg (Product-Specific)

Immunoglobulin G product code — billed per 500mg. Brand-specific J-codes are required (J1566 for Gamunex-C, J1557 for Gammaplex, J1559 for Hizentra SCIG). Using J3490 when a specific code exists creates audit risk.

Drug cost varies by dose — weight-based
J7613
Albuterol — Unit Dose For Inhalation (Per mg)

Albuterol inhalation solution administered in-office during spirometry or for acute bronchospasm — separately billable from the spirometry code. Billed per milligram of albuterol used.

~$4–$8 per unit dose (in-office)

Critical Asthma/PFT Billing Rules

94060 Replaces 94010 — Do Not Bill Both

When pre-bronchodilator AND post-bronchodilator spirometry is performed in the same session, bill 94060 only — not 94010 plus 94060. NCCI bundles these codes — billing both creates a duplicate billing flag.

Bronchodilator Separately Billable — J7613 Not Included in 94060

The bronchodilator administered during pre/post spirometry is NOT included in the 94060 code — it is separately billable as J7613 when administered from office stock.

IVIG — Product-Specific J-Codes Required

Each IVIG product has its own J-code — using J3490 (not otherwise classified) when a specific J-code exists for the product billed creates audit exposure. Document the specific product NDC on every IVIG claim.

Prior Authorization Intelligence

The Biologic PA War Room — Every Drug, Every Payer, Every Requirement

Biologics in allergy & immunology carry the most complex prior authorization requirements in the specialty — step therapy mandates, eosinophil count criteria, diagnosis-specific PA processes, and annual renewal requirements. One PA failure on a single biologic claim can cost thousands of dollars in denied revenue.

Omalizumab
Xolair — J2357
High PA
Moderate-severe allergic asthma (IgE-mediated) and chronic idiopathic urticaria. Two separate PA pathways — asthma criteria vs. urticaria criteria differ significantly.
IgE level documentation (total serum IgE and allergen-specific IgE)
Step therapy: failed ICS + LABA for asthma; failed antihistamines for urticaria
Weight-based dosing table documentation required for correct unit calculation
Annual PA renewal with response documentation required by most payers
J2357 — per 5mg | Admin: 96372
Dupilumab
Dupixent — J0223
Extensive PA
Atopic dermatitis (moderate-severe), asthma (eosinophilic or OCS-dependent), CRSwNP, and eosinophilic esophagitis. Four separate PA pathways — each indication has distinct criteria.
Indication-specific step therapy — varies dramatically by diagnosis
Asthma: eosinophil count or OCS-dependence documentation required
AD: EASI or IGA score, prior topical therapy failures (TCS + TCI)
PA must specify indication — wrong indication = denial even with active auth
J0223 — per 1mg | Admin: 96372 | Loading dose: 600mg
Mepolizumab
Nucala — J2182
High PA
Severe eosinophilic asthma, EGPA (eosinophilic granulomatosis with polyangiitis), and hypereosinophilic syndrome (HES). Indication-specific PA with different criteria per condition.
Eosinophil count ≥150 cells/μL (at initiation) or ≥300 cells/μL (historical)
Prior ICS + LABA failure documented
Exacerbation history documentation (frequency and severity)
Annual renewal — must document response (reduced exacerbations, OCS reduction)
J2182 — per 1mg | Admin: 96372 | Dose: 100mg Q4W
Benralizumab
Fasenra — J0517
High PA
Severe eosinophilic asthma. Unique dosing schedule: every 4 weeks for first 3 doses then every 8 weeks. The 8-week interval creates a non-standard billing calendar that must be tracked precisely.
Blood eosinophil count ≥300 cells/μL documentation required
Prior ICS + LABA failure + add-on controller therapy failure
Every-8-week maintenance: PA must cover variable dosing schedule
Billing gap tracking essential — claims may be 8 weeks apart in maintenance
J0517 — per 1mg | Admin: 96372 | Dose: 30mg
Tezepelumab
Tezspire — J3241
Extensive PA
Severe uncontrolled asthma — broadest indication of any asthma biologic (no eosinophil count threshold). PA criteria still evolving as newer payer policies develop.
Severe uncontrolled asthma on high-dose ICS + additional controller documentation
No minimum eosinophil count — but biomarker documentation still strongly recommended
Most payers require failure of ≥1 other biologic for non-eosinophilic phenotype
Payer coverage policies less standardized than older biologics
J3241 — per 1mg | Admin: 96372 | Dose: 210mg Q4W
IVIG / Immunoglobulin
Gamunex-C / Hizentra
Moderate PA
IVIG (intravenous immunoglobulin) for primary immune deficiency disorders (PIDD), autoimmune conditions, and CVID. SCIG for patients transitioning from IVIG to home-based therapy.
Specific diagnosis code required — CVID (D83.9), primary immune deficiency (D84.9)
IgG level documentation (trough levels) required for dosing and PA justification
Dose calculation per kg body weight — monthly or variable frequency
Product-specific J-code required — J1566, J1557, J1561, J1569 by brand
J1566/J1557/J1561 — per 500mg | Admin: 96365–96366
Testing Revenue Reference

Allergy Testing CPT Quick Reference — Codes, Units & Revenue Benchmarks

Every allergy testing service with CPT code, unit structure, typical Medicare reimbursement benchmark, and critical billing notes — all in one reference table.

Test Type / Description
CPT Code
Unit Structure
Medicare ~Rate
Key Billing Note
Percutaneous Testing
Percutaneous Prick / Scratch TestImmediate hypersensitivity, per allergen
95004
Per test (allergen)
~$4.20/unit
Must count every allergen — 60 allergens = x60 units
Intradermal Testing
Intradermal Test, w/o Re-testImmediate hypersensitivity
95024
Per allergen
~$9.80/unit
Cannot bill same allergen as 95004 AND 95024 same day w/o justification
Intradermal Test, w/ Re-testDelayed hypersensitivity, two reads
95028
Per allergen
~$14.50/unit
Both 15-min and 4–8hr reads must be documented
Patch Testing
Patch TestContact allergy, per antigen applied
95044
Per antigen
~$3.60/unit
Standard T.R.U.E. TEST = 36 antigens = x36 units
Challenge Testing
Ingestion Challenge — First 120 minOral food or drug challenge
95076
Per session (first 2hr)
~$225.00
95079 for each additional 60 min beyond 2hr
Immunotherapy
Allergy Immunotherapy — Single InjectionAdministration per visit
95115
Per visit
~$28.00
For 2+ injections in same visit, use 95117 instead
Inhalant Allergen PreparationProfessional service, per dose
95165
Per dose
~$7.80/dose
Separately billable from administration — most missed code in allergy
Venom Immunotherapy Prep — 1 SpeciesProfessional preparation
95145
Per preparation
~$38.00
95145–95149 by number of species — higher reimbursement than inhalant prep
Complete Service Suite

Everything ParaMed Manages in Your A&I Practice

Select any service below to see exactly what our A&I-certified billing team delivers — with the specialty detail that transforms each service from a cost center into a revenue driver for your allergy and immunology practice.

01
Testing Coding
02
Immunotherapy
03
Biologic + PA
04
Denial Mgmt
05
Analytics
01 — Allergy Testing Coding

Allergy Testing Billing — Unit Precision on Every Panel

Our A&I coders are trained on the per-unit billing rules for every testing method — percutaneous (95004), intradermal (95024/95028), patch testing (95044 per antigen), provocation challenge (95076/95079), and in vitro serum IgE testing (86003). For every testing encounter, we verify the unit count from the testing record, apply the correct code family based on testing method, confirm NCCI edit compliance for same-day test combinations, and apply Modifier -25 with documentation review when E/M services were performed on the same day.

Per-unit count verification every panel
Method-based code selection (prick vs. ID vs. patch)
NCCI same-day test combination compliance
Modifier -25 documentation review
Payer max-unit limit tracking
In vitro serum testing code accuracy

Testing Billing Standards

Unit Count From Testing Record — Verified Before Submission

Every testing claim unit count is verified against the allergen testing record before submission — not estimated or defaulted to a standard panel number.

Documentation Completeness Review

Testing claims are reviewed for documentation of allergen list tested with results, testing method, and reading time — the elements payers require for testing claims.

NCCI Edit Pre-Submission Check

Same-day testing combinations are checked against current NCCI edit tables before submission — preventing automatic denials from prohibited code combinations.

Payer-Specific Unit Limit Management

Maximum billable units per session vary by payer — we maintain payer-specific unit limit rules and apply them pre-submission to prevent maximum-unit denials.

02 — Immunotherapy Billing

Complete Immunotherapy Billing — Preparation + Administration + Venom

Our immunotherapy billing process captures both billable components on every immunotherapy encounter: the extract preparation professional service (95165 for inhalant, 95145–95149 for venom by species count) and the injection administration (95115 for single-extract visits, 95117 for multi-extract visits). We track each patient's immunotherapy protocol — build-up, cluster, or maintenance — and apply the correct billing approach based on the phase. Venom immunotherapy uses a separate code family from inhalant SCIT and requires tracking by species count for preparation billing.

Both preparation AND administration billed every visit
Venom species count for 95145–95149
Build-up vs. maintenance phase tracking
Split-billing for multi-provider groups
SLIT tablet billing with PA management
95115 vs. 95117 per-visit injection count

Immunotherapy Billing Standards

Two-Component Billing — Always Both

No immunotherapy encounter is submitted without verifying that both the preparation and administration components have been captured.

Venom Species Count Verification

For venom immunotherapy patients, the species count in the preparation determines the preparation code (95145–95149). We verify species count from the clinical venom protocol.

Phase Documentation — Build-Up vs. Maintenance

The patient's current treatment phase is tracked — build-up patients generate higher monthly administration revenue (weekly visits) vs. maintenance patients (monthly visits).

Split-Billing — Preparation by Allergist, Administration by Nurse

When the allergist prepares the extract and nursing staff administers the injection, billing attribution is correctly assigned per provider with appropriate modifier and supervision level documentation.

03 — Biologic Drug Billing + PA Management

End-to-End Biologic Revenue Management — J-Code to PA to Reimbursement

Our biologic billing process covers every step from PA submission to claim payment. Prior to initial biologic administration, we manage the PA submission process — compiling step therapy documentation, eosinophil count records, prior medication failure documentation, and diagnosis-specific criteria into a complete PA package. After PA approval, we track the authorization validity window and generate PA renewal requests 4–6 weeks before expiration. For every biologic administration, we verify the J-code, calculate the dose-to-unit conversion, document the NDC, and submit both the J-code and 96372 administration code on the claim.

Drug-specific J-code with dose-accurate unit calculation
NDC documentation on every biologic claim
PA submission and tracking from initiation
PA renewal 4–6 weeks before expiration
96372 administration code always submitted
15-day priority follow-up on all biologic claims

Biologic Billing Standards

Dose-to-Unit Calculation — Verified Per Drug Per Claim

Each biologic has a different unit increment in its J-code. We maintain a drug-specific unit calculation reference and verify the unit count on every biologic claim against the administered dose.

PA Expiration Tracking — Automated Renewal Alerts

Every active biologic PA has its expiration date tracked. Renewal requests are triggered automatically at the 4–6 week pre-expiration window so biologics are never administered without active coverage.

Priority Claims Monitoring — 15-Day Follow-Up

All biologic claims are flagged for priority follow-up at 15 days post-submission — confirming adjudication status and identifying any pend or denial requiring immediate response.

Indication-Specific PA Packages — Not Generic Submissions

Each biologic PA submission is built specifically for the drug and indication — not a generic template. Omalizumab for asthma vs. omalizumab for urticaria use entirely different PA documentation packages.

04 — Denial Management & Appeals

A&I-Specific Denial Management — Appeals Built on Clinical Knowledge

Allergy & immunology denials require clinical billing knowledge to appeal effectively. A testing unit-count denial requires an appeal that references the allergen testing record and explains the per-unit billing methodology. A biologic PA denial requires a peer-to-peer process with clinical documentation of the step therapy completed and the clinical criteria met. Our denial management team builds every A&I appeal on the specific clinical and billing logic relevant to the denied service — not generic form letters.

Testing unit-count denial appeals
Biologic PA peer-to-peer coordination
Immunotherapy preparation code appeals
Medical necessity LCD-aligned arguments
Denial pattern prevention feedback loop
Zero-balance pursuit on all recoverable claims

Denial Management Standards

72-Hour Denial Response — High-Dollar Priority

Biologic drug denials receive a 72-hour response initiation standard. Testing and immunotherapy denials are worked within 5 business days.

Clinical-Knowledge Appeals — Not Generic Templates

Every A&I appeal is built on the specific billing rule or clinical documentation standard relevant to the denied service.

Denial Pattern Tracking — Prevention Over Recovery

Denial patterns are analyzed monthly — recurring denials in the same code category trigger a pre-submission process change to prevent the denial from occurring again.

Peer-to-Peer Facilitation for Biologic PAs

When biologic PA is denied on initial submission, we coordinate the peer-to-peer review process — preparing the clinical documentation package for the allergist's peer-to-peer call.

05 — Revenue Analytics & Reporting

A&I Revenue Intelligence — Tracking Every Service Category

Our monthly A&I performance reports break down revenue, denial rates, and collection rates across all four service categories — testing, immunotherapy, biologics, and E/M. Reports include testing revenue per encounter (with unit-count accuracy metrics), immunotherapy revenue per patient (preparation + administration combined), biologic revenue per patient by drug with PA success rate, and compliance metrics for high-risk billing areas (Modifier -25 usage, NCCI edit compliance, NDC documentation rate). Every monthly report includes a comparison to the prior month's baseline and the pre-engagement audit finding.

Testing revenue per encounter with unit accuracy
Immunotherapy prep + admin combined reporting
Biologic revenue per drug with PA success rate
Compliance metrics dashboard
Month-over-month performance comparison
Baseline vs. current revenue tracking

Analytics Standards

Service-Line Revenue Breakdown

Revenue is broken down by service line in every monthly report — testing vs. immunotherapy vs. biologics vs. E/M — so you can see exactly which category is performing.

Compliance Monitoring Dashboard

Key compliance metrics tracked monthly: Modifier -25 usage rate, NDC documentation compliance, testing unit-count accuracy rate, and biologic PA validity rate.

Baseline vs. Current — Accountability Every Month

Every metric is compared to the pre-engagement audit baseline. Your monthly report shows exactly what has improved since ParaMed started managing your billing.

Alert System — Declining Metrics Flagged Immediately

When any metric shows a statistically significant decline vs. the prior month, our analytics system flags it for immediate root-cause investigation.

Payer Intelligence

A&I Billing by Payer — What Every Major Plan Does Differently

Allergy & immunology payer rules vary more than almost any other specialty — testing unit limits, biologic PA criteria, immunotherapy coverage policies, and SLIT coverage determinations all differ payer by payer.

Medicare Traditional (CMS)

CMS, MAC-specific LCDs

Medicare covers most allergy testing, immunotherapy, and medical management services — with LCD-based coverage for specific testing procedures and biologic drugs based on NCD/LCD criteria.

Allergy testing covered with documented clinical indication — LCD requirements vary by MAC
Omalizumab (J2357) and mepolizumab (J2182) covered under Medicare Part B with diagnosis criteria
SCIT preparation and administration both covered — documentation requirements strict
Refraction-equivalent: SLIT drops not covered by Medicare

Medicare Advantage Plans

Humana, UHC, Aetna, BCBS MA

MA plans follow Medicare coding rules but frequently have more restrictive biologic PA requirements and may have testing unit limits more restrictive than traditional Medicare.

Biologic PA requirements often more restrictive than traditional Medicare
Step therapy requirements for biologics may require MA-specific formulary step therapy
Testing unit limits may differ from traditional Medicare — verify per plan
SLIT tablet coverage inconsistent — many MA plans exclude SLIT entirely

Commercial — BCBS, Aetna, Cigna

PPO/HMO commercial plans

Commercial payers cover allergy services but have widely varying testing unit limits, biologic PA criteria, and immunotherapy coverage policies. Commercial plans are the most variable payer segment for A&I billing.

Allergy testing unit limits vary significantly — some plans limit to 80 units, some to 150+
Biologic PA requires indication-specific step therapy documentation
SCIT covered by most commercial plans — SLIT tablet coverage inconsistent
In-office biologic vs. specialty pharmacy — some plans redirect to specialty pharmacy

UnitedHealthcare

UHC — complex A&I policies

UHC has extensive A&I medical policies covering testing limits, biologic step therapy requirements, and immunotherapy coverage — among the most complex of the national commercial payers for allergy services.

UHC testing unit limits among strictest — maximum units per session lower than many payers
Biologic step therapy requirements specify preferred biologics by indication
SLIT tablets — coverage requires PA with allergy testing and failure of SCIT documentation
Complex immunodeficiency IVIG coverage requires quarterly IgG trough level documentation

Medicaid Programs

State Medicaid, managed MCO

State Medicaid programs vary widely in allergy coverage — most cover basic allergy evaluation but have limited or inconsistent coverage for testing, immunotherapy, and biologics.

Allergy testing covered with PA in many state Medicaid programs
Biologic coverage varies by state — some Medicaid programs cover with PA, others don't
SCIT coverage inconsistent — some states require PA for immunotherapy
Managed Medicaid plans add additional coverage limitations beyond state baseline

Biologic Specialty Pharmacy

Buy-and-bill vs. pharmacy model

Some commercial plans redirect biologic administration to specialty pharmacy — requiring different billing workflows and drug acquisition processes.

Buy-and-bill model: practice acquires drug, bills J-code + admin to payer
Specialty pharmacy model: payer directs drug to pharmacy, practice bills admin only (96372)
Verify drug acquisition pathway before ordering biologic for office administration
340B programs for qualifying entities — different billing rules apply to 340B-acquired drugs
The Practice Transformation

Allergy & Immunology Billing Before & After ParaMed

Performance Metric

Without ParaMed

Generalist billing average

With ParaMed

A&I specialty standard

Allergy Test Unit Count Accuracy
Flat-unit billing on 60–80% of panels — systematic undercounting
Per-unit count verified against testing record on 100% of claims
Immunotherapy Preparation Component Capture
50–70% of practices bill only administration — preparation code never submitted
Both preparation (95165/95145–95149) and administration always billed
Biologic J-Code Unit Calculation Accuracy
Unit errors on 30–50% of biologic claims — wrong dose-to-unit conversion
Drug-specific unit calculation verified on 100% of biologic claims
Biologic Prior Authorization Active Rate
PA lapses on 15–30% of biologic administrations annually — no tracking
100% PA validity verified before every biologic administration
Modifier -25 on Same-Day E/M + Testing
E/M denied on most same-day testing visits — Modifier -25 missing or undocumented
Modifier -25 documentation review on every same-day E/M + test encounter
Spirometry Pre/Post + Bronchodilator Billing
Base code only (94010) billed — 94060 substitution and J7613 both missed
94060 substitution applied and J7613 billed on every pre/post PFT
Overall A&I Claim Denial Rate
18–28% denial rate with generalist billing — specialty rules not applied
Under 3.5% denial rate maintained month over month
Annual Revenue Impact Per Allergist FTE
$80K–$280K+ in preventable annual losses per allergist
$80K–$280K+ recovered and protected with full compliance confidence
Proven A&I Outcomes

Revenue Results Across All Four A&I Service Categories — Tracked & Reported Monthly

Get My Audit
98%
Clean Claim Rate
+27%
Avg. Revenue Lift
100%
Biologic PA Tracking
Zero
Biologic PA Lapses
Onboarding Journey

From Free Audit to First A&I Claim — 10 Business Days

Every A&I onboarding starts with a free specialty audit covering testing unit accuracy, immunotherapy billing gaps, biologic PA status, and spirometry code completeness — delivered as a written report within 48 hours.

01
Day 1–2

Free A&I Billing Audit

We review a 90-day sample of your claims — testing unit counts, immunotherapy preparation billing, biologic J-code accuracy and PA status, and spirometry code selection. Written revenue impact report in 48 hours.

Testing unit review
PA status check
Written report
02
Day 2–5

Practice Protocol Build

We document your complete A&I service mix — testing methods, immunotherapy protocols (SCIT/SLIT/venom), biologic drugs administered with dosing schedules, spirometry services — and build your practice-specific billing protocol with payer-specific unit limits.

Service mix mapping
Payer unit limits
Bio PA calendar
03
Day 4–7

Biologic PA Setup

We establish a PA tracking calendar for every biologic patient — documenting current PA status, expiration dates, and renewal windows. Any PA approaching expiration receives an immediate renewal submission.

PA calendar setup
Renewal alerts
Step therapy docs
04
Day 8–10

First Claims Submitted

First A&I claims submitted within 24 hours of documentation receipt. Every testing claim is reviewed for unit count accuracy. Every biologic claim is verified for J-code, unit calculation, NDC, and active PA before submission.

24hr submission
Pre-submit review
All 4 categories
05
Day 30+

30-Day Performance Review

First monthly dashboard delivered — service-line revenue breakdown (testing, immunotherapy, biologics, E/M), denial rate by category, biologic PA success rate, and a direct comparison vs. the pre-engagement audit baseline.

Service-line breakdown
Before vs. after
Full dashboard
From Allergists & Immunologists

What A&I Practices Say After Switching to ParaMed

Real outcomes from allergists, immunologists, and A&I practice administrators who replaced generalist billing with ParaMed's specialty-certified team.

"
"Our previous billing team had been billing 95004 x 1 on every testing encounter for years. A standard 60-allergen prick test panel was being submitted as one unit when it should have been 60 units. ParaMed audited six months of testing claims and quantified the under-billing at $2,800 per month — $33,600 per year — from that single unit-counting error alone. After correcting it, our testing revenue per encounter increased by an average of $74. That's real money that was just being left on the table."
Dr. Sarah
Allergist-Immunologist — Solo Practice, High-Volume Testing
+$33,600/yr from testing unit correction
"
"The immunotherapy preparation billing issue was invisible to us because we didn't know it existed. Our billing team was billing 95115 for every injection visit — the administration code — but never billing 95165 for the extract preparation professional service. ParaMed identified this in the audit and explained that the preparation component is worth $7–10 per dose. Across our 180 active immunotherapy patients receiving monthly maintenance injections, that was $1,260–$1,800 per month in unbilled revenue. It's now being captured on every immunotherapy encounter."
Lisa H
Allergy & Immunology Group — 180 Active Immunotherapy Patients
+$1,260–$1,800/mo from 95165 preparation billing
98%
Client Retention Rate
<48hr
Audit Report Delivery
10 Days
Avg. Onboarding Time
400+
A&I CPT Codes Managed
Start With a Free Audit

Request Your Free A&I Billing Audit

We review your testing unit accuracy, immunotherapy preparation billing, biologic J-code correctness, PA status for every active biologic patient, and spirometry code completeness — and deliver a written revenue impact report within 48 hours showing exactly what your practice is leaving behind in each category.

Testing Unit Accuracy Audit

We sample your recent allergy testing claims and compare the billed unit count against the allergen testing records — quantifying the per-encounter and monthly revenue gap from unit undercounting across all testing methods.

Immunotherapy Preparation Revenue Review

We check whether your immunotherapy billing includes the extract preparation component (95165/95145–95149) on every encounter — and calculate the monthly revenue impact of the preparation code gap across your active immunotherapy patient panel.

Biologic J-Code + PA Status Review

We review your biologic claims for J-code accuracy, unit calculation correctness, and NDC documentation completeness — and check the current PA status for every active biologic patient, identifying any PAs approaching expiration or already lapsed.

Written Revenue Impact Report

All findings are documented with specific dollar estimates per revenue category — so you have a precise, per-category ROI calculation before making any decision about changing your billing approach.

"The audit found $33,600 per year in testing revenue from unit-counting alone, plus $15,000 in missed preparation codes, plus $11,000 in biologic claims that had been denied for PA lapses. I signed the agreement before I'd finished reading the report."
— Dr. Sarah — Allergy Practice, Solo Practitioner

Request My Free A&I Billing Audit

No cost. No commitment. A written report showing exactly what your allergy & immunology practice is leaving behind — across all four A&I revenue categories.

Audit covers: Testing unit accuracy, immunotherapy preparation, biologic J-codes, PA status, spirometry codes, Modifier -25 compliance

HIPAA-compliant. Your information is never shared. We respond within 1 business day.

ALLERGY & IMMUNOLOGY
Every Test. Every Dose. Every Code.

Stop Losing Allergy Revenue to a Billing Team That Can't Count Allergens or Manage Biologic PAs.

From the unit count on a 60-allergen prick test panel to the exact J-code unit calculation on a dupilumab administration to the PA renewal that prevents a $3,000 biologic denial — ParaMed's A&I-certified billing specialists manage every detail of your allergy and immunology revenue cycle with the precision that your clinical work demands and your practice finances require.

Testing Unit Precision
Immunotherapy Experts
Biologic PA Masters
Asthma & PFT Billing
HIPAA Compliant