Allergy & Immunology Billing Services

Allergy and immunology billing combines high-volume allergy testing codes, multi-dose immunotherapy administration, expensive biologic J-code management, and pulmonary function testing — a specialty where test-count accuracy and injection-log documentation determine reimbursement.

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95004Percutaneous Test

95115Immunotherapy

J0881Biologic

94010Spirometry

Why Allergy & Immunology Billing Requires Specialty Expertise

Allergy and immunology billing revolves around allergy testing codes (95004 percutaneous, 95024 intracutaneous, 95044 patch testing), immunotherapy administration (95115-95117 for injections, 95120-95134 for professional services with provision of antigen), biologic medication J-codes for severe allergic conditions, and pulmonary function testing (94010-94070). Test count accuracy is critical — each allergy test is billed per individual allergen, and a typical testing session involves 40-80 individual tests.

Common Allergy & Immunology CPT Codes

Our coders handle these allergy & immunology codes daily. This is not an exhaustive list.

Code

Description

95004

Percutaneous allergy testing, immediate hypersensitivity

95024

Intradermal allergy testing, immediate hypersensitivity

95044

Patch or application allergy test

95115

Allergen immunotherapy, one injection

95117

Allergen immunotherapy, two or more injections

95165

Allergen immunotherapy, antigen preparation, single multi-dose vial

94010

Spirometry

94060

Spirometry, pre and post bronchodilator

99213

Established patient office visit, low MDM

2026 Medicare Allowables for Allergy & Immunology CPT Codes by State

Medicare reimbursement for allergy & immunologyprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same allergy & immunology CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 9 core allergy & immunologycodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.

Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.

2026 Medicare non-facility allowable for Allergy & Immunology CPT codes across high-volume states
Code	Allergy & Immunology Procedure	CA	TX	FL	NY	PA	IL	OH	GA	NC	MI
95004	Percutaneous allergy testing, immediate hypersensitivity	$4.08	$3.61	$4.00	$4.16	$3.64	$3.88	$3.42	$3.60	$3.35	$3.63
95024	Intradermal allergy testing, immediate hypersensitivity	$8.83	$7.55	$8.02	$8.63	$7.56	$7.75	$7.07	$7.43	$7.09	$7.39
95044	Patch or application allergy test	$5.71	$4.91	$5.34	$5.67	$4.94	$5.15	$4.61	$4.86	$4.58	$4.87
95115	Allergen immunotherapy, one injection	$12.04	$10.18	$10.70	$11.63	$10.17	$10.32	$9.49	$9.96	$9.56	$9.88
95117	Allergen immunotherapy, two or more injections	$14.41	$12.15	$12.71	$13.87	$12.13	$12.26	$11.31	$11.87	$11.43	$11.77
95165	Allergen immunotherapy, antigen preparation, single multi-dose vial	$20.04	$17.12	$17.74	$19.32	$17.11	$17.17	$16.06	$16.75	$16.24	$16.59
94010	Spirometry	$33.91	$29.35	$30.44	$32.94	$29.34	$29.57	$27.70	$28.79	$27.92	$28.58
94060	Spirometry, pre and post bronchodilator	$49.92	$42.86	$44.17	$48.13	$42.80	$42.85	$40.32	$41.92	$40.79	$41.52
99213	Established patient office visit, low MDM	$104.31	$94.46	$98.20	$103.97	$94.79	$96.44	$90.97	$93.60	$90.84	$93.44

Full Allergy & Immunology fee detail by state

State:

2026 Medicare allowables for allergy & immunology CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.

2026 Medicare allowables for Allergy & Immunology CPT codes in California
Code	Description	Non-Facility	Facility
95004	Percutaneous allergy testing, immediate hypersensitivity	$4.08	$4.08
95024	Intradermal allergy testing, immediate hypersensitivity	$8.83	$0.92
95044	Patch or application allergy test	$5.71	$5.71
95115	Allergen immunotherapy, one injection	$12.04	$12.04
95117	Allergen immunotherapy, two or more injections	$14.41	$14.41
95165	Allergen immunotherapy, antigen preparation, single multi-dose vial	$20.04	$2.65
94010	Spirometry	$33.91	$33.91
94060	Spirometry, pre and post bronchodilator	$49.92	$49.92
99213	Established patient office visit, low MDM	$104.31	$59.65

Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.

Allergy & Immunology Billing Challenges We Solve

Common billing problems in allergy & immunology and how our team handles them.

High-Volume Test Count Billing

Allergy skin testing bills per individual allergen tested. A 60-allergen panel = 60 units of 95004. Inaccurate test counts directly reduce revenue or create audit risk.

Immunotherapy Administration Coding

Choosing between 95115 (single injection), 95117 (2+ injections), and 95120-95134 (professional component with antigen provision) depends on who prepared the antigen.

Biologic J-Code Management

Biologics like omalizumab (J2357), dupilumab (J0881), and mepolizumab (J2182) require prior authorization, weight-based dosing verification, and step-therapy documentation.

PFT Documentation Requirements

Pulmonary function tests require pre- and post-bronchodilator documentation, calibration records, and interpretation to support the code level billed.

Common Allergy & Immunology Denial Reasons

We prevent these before submission and appeal aggressively when they occur.

Allergy skin testing bills per individual allergen tested

Choosing between 95115 (single injection), 95117 (2+ injections), and 95120-95134 (professional component with antigen provision) depends on who prepared the antigen

Biologics like omalizumab (J2357), dupilumab (J0881), and mepolizumab (J2182) require prior authorization, weight-based dosing verification, and step-therapy documentation

Pulmonary function tests require pre- and post-bronchodilator documentation, calibration records, and interpretation to support the code level billed

Revenue Opportunities Most Allergy & Immunology Practices Miss

Accurate allergy test-count billing is the single largest revenue lever. A practice performing 15 allergy testing sessions per week with an average of 60 allergens per session should bill 900 units of 95004 weekly. At Medicare reimbursement of approximately $4 per test, that is $3,600 per week or $187,200 annually from skin testing alone. Practices that estimate rather than count actual allergens tested routinely under-bill by 15-25%, losing $28,000-47,000 per year. Biologic medication billing represents the highest per-patient revenue. Omalizumab (Xolair) at $800-3,000 per dose administered monthly, dupilumab (Dupixent) at $1,500-3,000 per dose biweekly, and mepolizumab (Nucala) at $2,800 per monthly injection create significant buy-and-bill revenue when administered in-office. A practice with 30 biologic patients generates $500,000-1,000,000 annually in drug and administration revenue.

Payer-Specific Allergy & Immunology Billing Tips

Medicare covers allergy testing with per-test reimbursement under the Physician Fee Schedule. Medicare limits percutaneous testing (95004) to 80 allergens per session in most MAC jurisdictions. Immunotherapy administration is covered with documentation of the allergens being treated and the treatment protocol phase (build-up vs maintenance). Commercial payers cover allergy testing broadly but may impose per-session allergen limits (typically 70-100 per session). UnitedHealthcare requires prior authorization for all biologic medications used in allergy treatment. Anthem BCBS mandates step-therapy documentation for omalizumab showing failure of standard asthma therapy. Aetna covers immunotherapy but requires a treatment plan documenting specific allergens, dose escalation schedule, and expected duration. Cigna's formulary prefers biosimilar options when available and requires failure of the biosimilar before approving the reference biologic. We maintain authorization workflows for every biologic and track payer-specific allergen testing limits.

Allergy & Immunology Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

Count every individual allergen tested and bill 95004 per allergen for percutaneous testing. A standard environmental and food panel of 60 allergens = 60 units of 95004. Many practices estimate test counts rather than counting actual allergens, losing 10-20% of testing revenue.

Immunotherapy administration coding depends on antigen source. If your practice prepares the antigen, bill 95120-95134 (which includes antigen provision). If an outside lab prepares the antigen and you only administer the injection, bill 95115 (single) or 95117 (two or more injections).

Biologic medications require step-therapy documentation. Omalizumab (J2357) typically requires documented failure of inhaled corticosteroids and long-acting beta-agonists. Dupilumab (J0881) requires failure of topical therapies for atopic dermatitis or documented moderate-to-severe asthma. Prepare step-therapy documentation before submitting authorization.

For pulmonary function testing, always perform and document pre- and post-bronchodilator spirometry (94010 + 94060) when evaluating asthma. The post-bronchodilator study is separately billable and demonstrates reversibility — a key diagnostic finding that supports ongoing treatment.

In-vitro allergy testing (86003 per allergen for IgE, 86005 for qualitative multi-allergen screen) is an alternative when skin testing is contraindicated. Bill each allergen separately, and document why skin testing could not be performed to justify the in-vitro approach.

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What We Handle for Allergy & Immunology Practices

Allergy skin testing billing (95004, 95024, 95044)

Immunotherapy injection administration coding (95115-95134)

Biologic medication J-code billing and authorization

Pulmonary function testing (94010-94070)

Serum preparation and antigen provision billing

Component testing and in-vitro allergy coding (86003-86005)

Food allergy and drug allergy testing

Prior authorization for biologics and advanced testing

Why Choose Go Medical Billing for Allergy & Immunology

Allergy billing is volume-dependent — accuracy on 60-80 individual test codes per session determines whether the practice is paid correctly. Our team counts every allergen tested, manages immunotherapy injection logs, and handles biologic prior authorization.

We serve allergy & immunology practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.

Allergy & Immunology Billing by State

We handle allergy & immunology billing in all 50 states. The 2026 Medicare allowables for allergy & immunology CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.

California Texas Florida New York Pennsylvania Illinois Ohio Georgia North Carolina Michigan New Jersey Virginia Massachusetts Arizona Tennessee Maryland Indiana Missouri Wisconsin Colorado

View all 50 states

Related Resources

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Frequently Asked Questions

We reconcile the number of allergens tested against the testing panel documentation and the claim. Every individual allergen is counted and billed as a separate unit of 95004, 95024, or 95044, ensuring the practice captures full reimbursement for every test performed.

Yes. We manage the full prior authorization process for omalizumab, dupilumab, mepolizumab, benralizumab, and other allergy biologics, including step-therapy documentation, clinical criteria submission, and appeal of initial denials.

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