Allergy & Immunology Billing Services

Allergy practices bill in a pattern most other specialties never see. One visit can include an office visit, a battery of skin tests, and a set of immunotherapy injections. Each piece has its own code, unit rules, and documentation needs. Extract preparation and injection services are billed separately from the testing that came before them.

Add in-office biologic injections for asthma and chronic hives, and the work grows more complex. Drug supply, buy-and-bill timing, and prior authorization all affect cash flow. Westmont Revenue Partners connects allergy and immunology practices with vetted billing experts who understand allergy billing at this level of detail.

Who this is for

• Allergists and clinical immunologists in private practice
• Multi-provider allergy groups with in-house extract mixing
• Practices that offer pediatric and adult allergy care
• Practices that give biologic injections in the office
• Allergy clinics inside larger multispecialty groups

What gets billed

• New and established patient office visits
• Percutaneous (skin prick) allergy testing
• Intracutaneous (intradermal) allergy testing
• Add-on allergens beyond the first test group
• Allergen extract preparation for immunotherapy
• Single allergen immunotherapy injections
• Multiple allergen immunotherapy injections in one visit
• Biologic drugs given in the office, such as omalizumab
• Observation time after injections
• Counseling on avoidance and treatment plans

Commonly billed codes

Code	Type	What it covers
99214	CPT	Established patient office visit at a moderate level
95004	CPT	Skin prick tests for allergens, billed per test
95024	CPT	Intradermal skin tests with allergen extracts, billed per test
95018	CPT	Skin testing with drugs or biologicals, such as a penicillin allergy test, per day
95165	CPT	Preparing allergen extract doses for immunotherapy
95115	CPT	One allergen immunotherapy injection
95117	CPT	Two or more allergen immunotherapy injections in one visit
J2357	HCPCS	Omalizumab injection, billed per 5 mg

Note

Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Billing challenges in allergy and immunology

Test unit counts. Skin tests are billed per test, so the count must match the chart. A biller checks the number of tests documented against the units on the claim before it goes out.

Extract preparation versus injection. Vial preparation and the injection visit are separate services. Many payers want the preparation tied to a documented treatment plan. A biller tracks vial dates and doses so each claim can be supported.

Single versus multiple injection codes. Choosing between the one-injection and multiple-injection codes depends on what was given at that visit. Errors here lead to denials or underpayment, so billers review injection logs.

Biologic drug billing. Drug codes depend on the exact product, dose, and units. Payers often require prior authorization and proof of diagnosis. A biller confirms authorization before the first dose is given.

Evaluation visits on injection days. An office visit on the same day as testing or injections may need a modifier and a separate, clear note. Experienced billers know when payers expect that support.

Supply and drug cost recovery. Buy-and-bill drugs tie up practice cash until payment arrives. A biller follows these claims closely so slow payments do not sit unnoticed.

Frequent payer-specific rules. Some payers limit testing numbers or require documented history before testing. A biller keeps payer policies on file and applies them before submission.

How Westmont can help

• Matching you with vetted billing experts who have allergy and immunology experience
• End-to-end revenue cycle support, from charge entry through payment posting
• Denial management for testing, extract, and biologic claims
• Credentialing support for new providers joining your practice
• Clear reporting so you can see where claims stand

Frequently asked questions

How are allergy skin tests billed?

Percutaneous and intradermal tests are billed with separate codes, and each is reported per test. The number of tests on the claim should match what the chart documents, including the allergens used. Payers may also set limits on test counts or ask for history that supports testing. A biller checks both before submitting.

Can I bill the extract and the injection separately?

Yes, extract preparation and the injection service are separate services with separate codes. Preparation is generally tied to a physician-directed treatment plan and the vial dates. Payers differ on documentation, so confirm each payer's policy. A billing expert can set up a log that makes both easy to support if a claim is questioned.

Why do biologic claims get denied?

Common reasons include missing prior authorization, a diagnosis that does not match payer criteria, and wrong drug units. Dose and product details must line up with the claim. Many payers also ask for chart notes that show prior treatments tried. A billing team can verify requirements before the first injection and track follow-up renewals.

Do I need a modifier when I bill a visit with allergy testing?

It depends on the payer and the note. When a visit is clearly separate from testing or injections, a modifier may be required to show that. Without one, payers may bundle the visit into the procedure. A biller reviews the documentation and applies the modifier only where the chart supports it.

Should an allergy practice outsource billing?

Many practices do when claim volume, drug billing, or staff turnover becomes hard to manage. Outsourcing can free staff for patient care. Westmont does not submit claims itself. We match you with vetted billing experts, and you choose whether the fit is right for your practice.

Related billing services

• Pulmonology Billing
• Dermatology Billing
• Infectious Disease Billing
• Pediatric Billing
• Infusion Center Billing