Allergy & Immunology Billing Services

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.