Allergy and immunology billing runs on precise per-test and per-dose coding — get the antigen preparation code, injection count, or same-day E&M modifier wrong, and clean claims turn into denials fast.
Common Billing Challenges
These are the six billing failure points we see most often in allergy and immunology practices — and the ones our team resolves systematically from day one.
95165 (antigen preparation), 95115 (single injection), and 95117 (two or more injections) are frequently confused, and the units billed don't match the doses actually prepared.
Billing both percutaneous (95004) and intradermal (95024/95027) testing for the same allergen on the same day is treated as a duplicate by some payers.
Allergen-specific IgE testing (95076, 95079) is lab-based and billed differently from skin testing — mixing the two up is a coverage-rule error, not just a coding one.
Billing 95165 for antigen preparation when a compounding pharmacy actually mixed it is a documented compliance error — if you didn't prepare it, you can't bill the professional component.
An E&M billed the same day as immunotherapy needs modifier -25 and its own independent documentation — using the immunotherapy note as the E&M note gets flagged by payers.
In-office spirometry (94010) performed the same day as allergy testing needs independent medical necessity documentation, or payers bundle the two and deny one.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in allergy and immunology.
| CPT Code | Description | Common Issue |
|---|---|---|
| 95004 | Percutaneous (scratch/prick) allergy testing | Unit-based — document each allergen and reaction |
| 95024/95027 | Intradermal testing (single / sequential) | Don't duplicate-bill same allergen as scratch testing same day |
| 95076/95079 | Allergen-specific IgE (lab-based) testing | Billed differently from skin testing — separate coverage rules |
| 95165 | Antigen preparation, per dose | Only billable if your practice actually prepared it, not outsourced |
| 95115/95117 | Immunotherapy injection (single / two or more) | Confirm units match doses actually administered |
| 94010 | Spirometry | Needs independent medical necessity documentation if billed same-day as allergy testing |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to allergy and immunology — not a generic CPC only.
Built around the precise per-dose and per-test coding rules where a single modifier or unit-count error is usually the difference between a paid claim and a denial.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your immunotherapy schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.