Allergy and immunology billing for practices and groups: skin and patch testing billed by the test, allergen immunotherapy split between the injection and the antigen, venom treatment, asthma biologics and immune globulin, worked inside the software you already use.
In allergy and immunology, billing is counting: tests, shots, doses and units, each by the payer’s rules. Tests are billed by count, immunotherapy is split into injection and antigen with each payer’s dose definition, biologics are billed by the unit, and claims that hit a payer edit are corrected and resent.
31.8%
of US adults had a seasonal allergy, eczema or food allergy in 2021, according to the CDC
25.7%
of US adults had a seasonal allergy, the most common of the three
Allergy billing counts things: tests, injections and doses of antigen. A skin test panel is billed by the number of allergens tested, and immunotherapy is billed in two parts, the shot and the antigen, with Medicare and commercial plans counting a dose of antigen differently. Get the count or the definition wrong, and the claim is underpaid, overpaid or denied by an edit.
The count and the dose definition decide the claim. That is why we check test counts, injection codes and antigen doses against each payer’s rules before claims go out.
Allergy practices bill tests, weekly shots and biologics for the same patients over months or years. Each is counted differently. Here is where each breaks, and what we do about it.
Pays forPercutaneous and intradermal skin tests, patch tests and supervised food and drug challenges.
Where it breaks
What we do
Pays forAllergy shots, billed as the injection and the antigen preparation, and venom immunotherapy.
Where it breaks
What we do
Pays forAsthma and allergy biologics given in the office, and immune globulin for immunodeficiency.
Where it breaks
What we do
Medicare does not accept the complete-service immunotherapy codes, 95120 to 95134. Instead, the injection and the antigen are billed separately: 95115 for one injection or 95117 for two or more, and 95165 for preparing the antigen from a multidose vial. Since 2001, Medicare has defined a 95165 dose as a 1 cc aliquot of extract, whatever amount the patient actually receives, so a 10 cc vial can be billed as at most 10 doses.
Commercial plans often use the CPT definition instead, the amount given in a single injection, so the same vial can be billed differently by payer. CMS asked for comments on its dose definition in the proposed 2027 fee schedule (July 2026), so we watch for a change in the final rule.
What we do: before an immunotherapy claim goes out, we separate the injection and antigen lines, count the antigen doses by each payer’s definition, and check the units against the vials prepared and the payer’s edits.
Allergy and immunology claims count tests, doses and units. These are the codes we see most, with what each payer checks.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 25 with a same-day procedure only when the visit is separate. |
| 95004 | Percutaneous allergy tests | Units equal to the number of allergens tested. |
| 9502495027 | Intradermal tests, immediate and sequential | Units per test, with the reason for intradermal testing. |
| 95044 | Patch tests | Units per patch applied. |
| 9507695079 | Ingestion challenge testing, first 2 hours and each additional hour | Time documented, with physician attendance. |
| 9511595117 | Allergen immunotherapy injections, one or more | Billed with 95165 for the antigen, not with the complete-service codes for Medicare. |
| 95165 | Antigen preparation, multidose vials | Medicare: 1 cc per dose; commercial plans may count per injection. |
| 95145 to 95149 | Venom immunotherapy antigen | By the number of venoms in the extract. |
| 9401094060 | Spirometry, before and after a bronchodilator | 94060 includes 94010. |
| J2357 | Omalizumab, per 5 mg | Units from the dose, authorization and reauthorization. |
A visit significant and separate from same-day testing or injections. Modifier 25 explained
Required by Medicare on single-dose drugs when the whole dose was given.
The unused part of a single-dose vial, billed on its own line.
Testing types normally bundled but separately performed and documented. Our modifier 59 guide
Medicare: a test or treatment that may not be covered, with a signed notice.
Video follow-up visits for plans that ask for it.
Sources: Medicare Claims Processing Manual, chapter 12, section 200; CMS CY 2027 Physician Fee Schedule proposed rule (CMS-1848-P); CMS JW and JZ Modifier FAQs. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, test counts, immunotherapy injection and antigen billing, biologic authorizations, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list patients on immunotherapy and biologic authorizations, and agree how escalations work. Most practices are live within one to two weeks.
Tests, injections and visits are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, test counts, dose definitions and units checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Allergy practices bill many small claims, weekly shots and test panels, plus a few high-value biologics. A share of collections means our fee follows what those claims actually pay, not how many there are.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on injection and testing volume, how many patients are on biologics, your Medicare share and the state of the receivables, which the free account review shows.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, test counts, immunotherapy injection and antigen billing, and biologic authorizations, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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