First-Pass Clean Claim Rate
Avg. Monthly Revenue Recovered
Average Days to Payment
Client Denial Rate
Allergy and immunology billing requires specialized knowledge of percutaneous and intradermal testing codes, immunotherapy injection protocols, and the payer-specific rules that govern reimbursement for these services. Practices that handle their own billing frequently leave revenue on the table because of incorrect modifier usage on multi-test encounters or missed opportunities to bill component testing separately.
Our billing team understands the nuances of allergy testing panels, from skin prick tests (95004) to intradermal sequential testing (95017, 95018), and the documentation requirements that payers demand before approving immunotherapy treatment plans. We handle prior authorizations for biologic medications like omalizumab and dupilumab, track vial preparation billing (95165), and ensure your practice captures every billable unit across complex multi-allergen testing sessions.
Every Allergy and Immunology billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
Allergy testing sessions often involve 50 or more individual percutaneous tests (95004) followed by intradermal testing (95024). Each payer has different rules on maximum billable tests per session, and incorrect bundling can cost practices thousands in denied claims per month.
Immunotherapy protocols span months or years, requiring ongoing prior authorizations. Payers frequently require updated documentation of treatment efficacy, and missed renewal deadlines result in coverage gaps that leave patients responsible for injection costs.
High-cost biologics like omalizumab (J2357) and dupilumab (J0593) require buy-and-bill processes with specific documentation of medical necessity, step therapy compliance, and ongoing outcome reporting to maintain payer approval.
Payers differ on whether allergen-specific IgE tests should be billed as individual components (86003) or as panels (86005). Billing the wrong way triggers automatic denials, and appeal processes vary significantly across commercial carriers.
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
Allergy skin test coding (95004, 95017, 95018, 95024)
Immunotherapy injection billing (95115, 95117, 95120, 95125)
Biologic medication buy-and-bill management
Prior authorization for allergy testing panels
In-vitro allergen-specific IgE coding (86003, 86005)
Vial preparation and mixing charge capture (95165)
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
Allergy and immunology billing requires specialized knowledge of percutaneous and intradermal testing codes, immunotherapy injection protocols, and the payer-specific rules that govern reimbursement for these services. Practices that handle their own billing frequently leave revenue on the table because of incorrect modifier usage on multi-test encounters or missed opportunities to bill component testing separately.
Our billing team understands the nuances of allergy testing panels, from skin prick tests (95004) to intradermal sequential testing (95017, 95018), and the documentation requirements that payers demand before approving immunotherapy treatment plans. We handle prior authorizations for biologic medications like omalizumab and dupilumab, track vial preparation billing (95165), and ensure your practice captures every billable unit across complex multi-allergen testing sessions.
Answers to the questions practice owners and managers ask most often before switching billing partners.
We code each percutaneous test using 95004 with the correct number of units, verify payer limits on tests per session, and apply appropriate modifiers when intradermal testing (95024) follows in the same encounter. Our team tracks payer-specific maximums to prevent denials before submission.
Most commercial payers reimburse immunotherapy injection claims (95115, 95117) within 14 to 21 days when submitted with proper documentation. We track each patient's authorization status and renewal dates to prevent coverage lapses that delay payment.
Yes. We manage the full prior authorization process for biologics including omalizumab and dupilumab, from initial submission with clinical documentation through appeals if the initial request is denied. Our approval rate for biologic authorizations exceeds 92%.
We audit every claim against payer-specific rules before submission, verify that testing documentation supports medical necessity, and ensure modifier usage aligns with each carrier's requirements. This pre-submission review reduces first-pass denial rates to under 4% for our allergy clients.
Yes, when medically appropriate and supported by documentation. We apply modifier 59 or XS to distinguish the testing service from the injection administration, following each payer's specific bundling rules to ensure both services are reimbursed.
We deliver monthly reports covering revenue by service type (testing, injections, biologics), denial rates by payer, authorization renewal schedules, and aging accounts receivable. You also receive quarterly trend analysis showing revenue per patient visit.
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
Get a revenue review and a clear action plan tailored to your practice, payers, and claim mix.