Allergy and Immunology BillingComplete Coding & Revenue Guide (2026)Top CPT codes with current RVU data, denial patterns, modifier rules, bundling pitfalls, and revenue opportunities for allergy and immunology practices.
Top CPT Codes
The highest-value allergy and immunology CPT codes with current RVU data and Medicare payment from the CY 2026 Physician Fee Schedule. Click any code for the full payment, bundling, and modifier guide.
Most practices under-capture revenue on these codes through downcoding, missed modifier 25, stale fee schedules, or misapplied bundling. Our coders audit every line against the documentation before submission so the revenue earned actually gets billed.
Bundling Pitfalls
2 trapsThe code pairs that trigger NCCI edits and CO-97 denials in allergy and immunology. Know these before billing.
95004: 95024: Percutaneous skin prick testing (95004) and intradermal testing (95024) can be billed on same date but for DIFFERENT allergens. Cannot bill both for the same allergen.: 95004: 95017: Skin prick testing (95004) can be billed with IgE testing (95017) on same date. They test different modalities (skin vs blood).: 95115: 95117: Immunotherapy injection: 95115 (single injection) vs 95117 (2+ injections). Cannot bill 95115 x 2 — if giving 2 injections, bill 95117 once.: 94010: 94060: Pre-bronchodilator spirometry (94010) bundles with post-bronchodilator (94060). If performing both, bill 94060 only.: 95165: 95120: Antigen preparation (95165 per dose) is separate from injection admin (95115/95117). Bill BOTH: 95165 x [number of antigens] + 95115 or 95117 for the injection.
95004: 99214: Allergy testing (95004 x 40-80 tests) same day as E/M: modifier 25 required on E/M. Document the clinical assessment separately from test interpretation.
CO-97 bundling denials are recoverable with correct modifier documentation. Most billers write them off. We work each one against the clinical record and resubmit with the right modifier 25 or 59 path.
Modifier Guidance
When to apply each modifier in allergy and immunology claims. Wrong modifier application is the top single-line denial trigger and a leading audit target.
Required on E/M when billing with same-day allergy testing, immunotherapy injection, or spirometry. Document clinical decision-making beyond the test/injection.
Professional component — use when interpreting PFTs performed at external lab.
Multiple procedures — some payers require modifier 51 on second procedure when performing multiple allergy test types same day.
Repeat procedure — use for repeat spirometry on same day (pre/post treatment for acute asthma).
Telemedicine — follow-up allergy visits (medication management, immunotherapy dose adjustment) work well via telehealth. Use POS 02.
Revenue Opportunities
7 playsThe billing codes and services most allergy and immunology practices under-capture. Each one is a recurring revenue lift, not a one-time fix.
Allergy testing revenue: Skin prick testing (95004 x 50 allergens) pays $250-400 per session. New patient evaluation + testing = $400-600 per initial visit. With 3-5 new patients/week = $60K-150K/year from testing alone.
Immunotherapy (allergy shots): 95165 (antigen prep) + 95115/95117 (injection admin) x weekly for 3-5 years per patient. Revenue: $50-80/visit x 50 visits/year x 100 patients = $250K-400K/year. This is the #1 recurring revenue stream in allergy.
Sublingual immunotherapy (SLIT): FDA-approved tablets (Grastek, Ragwitek, Odactra, Palforzia) — prescription revenue. Custom SLIT drops are patient-pay ($50-80/month). Growing market as patients prefer home therapy.
Biologic therapy: Omalizumab (Xolair) in-office injection — buy-and-bill revenue of $1,000-2,000/injection x monthly = $12K-24K/patient/year. With 20 biologic patients = $240K-480K/year.
Pulmonary function testing in-office: Spirometry (94010/94060) pays $40-80 per test. Allergy practices managing asthma should have in-office PFT equipment. With 5-10 PFTs/day = $50K-100K/year.
Patch testing for contact dermatitis: 95044 x panels (TRUE Test or custom) pays $200-400 per session. Valuable for occupational dermatitis referrals.
Documentation Checklist
What the chart must contain to support billing. Missing documentation means audit vulnerability.
- Allergy skin testing (95004): Document number of tests performed, specific allergens tested (list each), positive/negative results for each, wheal/flare measurements for positives, and clinical interpretation. Must be physician-supervised.
- Immunotherapy (95115/95117 + 95165): Document antigen(s) injected, dilution/concentration, dose (volume), injection site, observation period (20-30 min), and any adverse reactions. For antigen preparation: document number of doses prepared and antigens included.
- Asthma management (J45.x): Document asthma severity classification (intermittent, mild/moderate/severe persistent), control level (well-controlled, not well-controlled, very poorly controlled), current medications with step, PFT results (FEV1, FEV1/FVC), and action plan status.
- Anaphylaxis (T78.2): Document trigger (food, drug, venom, idiopathic), symptoms (skin, respiratory, cardiovascular, GI), treatment given (epinephrine dose/route, other medications), response to treatment, and discharge plan (EpiPen prescription, allergy referral, avoidance education).
- Drug allergy evaluation: Document the suspected drug, reaction description, timeline, alternative diagnosis considered, and if applicable, drug challenge protocol and results. Use Z88.x for allergy status coding.
Coding Workflow
Step by step approach for coding allergy and immunology encounters correctly.
1. Determine visit type: initial evaluation (99204/99205) vs follow-up (99213-99215) vs testing-only vs injection-only. 2. For allergy testing: select test type — skin prick (95004 x number of allergens), intradermal (95024 x number), specific IgE blood (95017/95018). Document each allergen tested. 3. For immunotherapy: bill antigen preparation (95165 x doses) + injection admin (95115 single or 95117 multiple). 4. For asthma: determine severity/control level, perform spirometry (94010/94060), document step therapy. 5. If E/M + testing/injection same day: add modifier 25 on E/M. 6. For food allergy: consider component testing and oral food challenge (95076/95079). 7. Check prior auth for biologic therapy (omalizumab, dupilumab, mepolizumab).
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Everything about Allergy and Immunology billing
What CPT codes does Allergy and Immunology bill most often?
Top Allergy and Immunology codes include 99214 (Established patient office visit, moderate MDM or 30-39 minutes); 99213 (Established patient office visit, low MDM or 20-29 minutes); 99215 (Established patient office visit, high MDM or 40-54 minutes); 99204 (New patient office visit, moderate MDM or 45-59 minutes); 95004 (Perq tests w/alrgnc xtrcs).
What are the most common denials in Allergy and Immunology billing?
Allergy and Immunology denials concentrate around medical necessity, bundling, prior authorization, and modifier errors.
Does Go Medical Billing handle Allergy and Immunology?
Yes. Go Medical Billing handles Allergy and Immunology billing with AAPC-certified coders, payer-specific scrub rules, and dedicated account management. Starting at 2.49 percent of collections with no setup fees.
Specialty content reviewed by AAPC-certified coders. CPT codes and descriptions are copyright of the AMA. Medicare payment varies by locality. Commercial rates vary by contract.
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