Allergy & Immunology Billing Services in Virginia

Virginia's allergy & immunology practices face unique billing challenges shaped by Anthem Blue Cross Blue Shield's commercial rules, Virginia Medicaid requirements, and Palmetto GBA Medicare policies. Our AAPC-certified coders specialize in both VA payer rules and allergy & immunology coding complexity.

AAPC Certified
VA Payer Expert
Allergy & Immunology Specialists
2.49% Rate
25,000+VA Physicians
2.49%Starting Rate
6Medicaid MCOs
98%+Clean Claim Rate

Why Virginia Allergy & Immunology Practices Need Specialized Billing

Virginia's healthcare market includes 25,000+ physicians, and allergy & immunology practices here face a payer market dominated by Anthem Blue Cross Blue Shield on the commercial side and Virginia Medicaid on the public payer side. Medicare claims are processed through Palmetto GBA, which applies its own Local Coverage Determinations that directly affect allergy & immunology procedure coverage and medical necessity requirements. Generic billing teams without VA specific knowledge leave revenue on the table.

Allergy & Immunology billing itself is complex. 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. When you combine this coding complexity with Virginia's specific payer rules, authorization requirements, and 6 Virginia Medicaid managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving allergy & immunology practices from Virginia Beach to Norfolk and across Virginia.

Top CPT Codes for Allergy & Immunology in Virginia

Our VA coders handle these allergy & immunology codes daily, applying Palmetto GBA Medicare rules and Anthem Blue Cross Blue Shield commercial policies to each claim.

Code
Description
95004
Percutaneous Test
95115
Immunotherapy
J0881
Biologic
94010
Spirometry

Virginia Payer Challenges for Allergy & Immunology

Every VA payer has specific rules for allergy & immunology claims. Here's how we navigate them.

Anthem Blue Cross Blue Shield Allergy & Immunology Claims

Anthem Blue Cross Blue Shield processes the largest share of Virginia commercial allergy & immunology claims. We know their VA specific fee schedules, prior authorization requirements for allergy & immunology procedures, and their appeal timelines when claims are denied. 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.

Virginia Medicaid Allergy & Immunology Billing

Virginia Medicaid routes allergy & immunology patients through 6 managed care plans: Anthem HealthKeepers, Aetna Better Health, Molina, and 3 more. Each MCO has its own allergy & immunology authorization and billing rules that we manage.

Medicare (Palmetto GBA) Allergy & Immunology Coverage

Palmetto GBA processes Medicare allergy & immunology claims in Virginia with its own Local Coverage Determinations. We navigate Palmetto GBA's policies around immunotherapy administration coding to prevent medical necessity denials.

Denial Prevention for Virginia Allergy & Immunology

Common allergy & immunology denials in Virginia include allergy skin testing bills per individual allergen tested and choosing between 95115 (single injection), 95117 (2+ injections), and 95120-95134 (professional component with antigen provision) depends on who prepared the antigen. Our team catches these issues before submission and appeals aggressively with VA payer-specific documentation when denials occur.

Get Expert Allergy & Immunology Billing in Virginia

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What We Handle for Virginia 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

Virginia Allergy & Immunology Billing Cost Comparison

Hiring an in-house biller with allergy & immunology expertise in Virginia costs $42K-$58K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified allergy & immunology coders and VA payer specialists for a fraction of that cost.

$42K-$58K

In-House Biller Salary

+ benefits, software, space

2.49%

Go Medical Billing Rate

Full team, all services included

60-80%

Typical Cost Reduction

With better results

Frequently Asked Questions

All major VA payers: Anthem Blue Cross Blue Shield, Optima, Sentara, Cigna, UHC, Virginia Medicaid (including Anthem HealthKeepers, Aetna Better Health, Molina), and Medicare through Palmetto GBA. If a payer accepts allergy & immunology patients in Virginia, we submit and follow-up on claims with them.
The most frequent allergy & immunology denials we see from VA payers include 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. Our team catches these before submission by applying both allergy & immunology coding expertise and VA payer-specific rules to every claim.
Virginia Medicaid routes allergy & immunology patients through 6 managed care plans: Anthem HealthKeepers, Aetna Better Health, Molina, Optima, Sentara, Virginia Premier. Each MCO has its own allergy & immunology authorization requirements, fee schedules, and billing rules. We credential and bill with all of them so your allergy & immunology practice gets paid correctly.
Most VA allergy & immunology practices are fully transitioned within two to three weeks. We connect to your EHR, learn your allergy & immunology workflows, and start submitting claims to Anthem Blue Cross Blue Shield, Virginia Medicaid, Medicare, and all your VA payers with no downtime.

Fix Your Virginia Allergy & Immunology Billing

Call 888-701-6090 for a free billing assessment specific to your VA allergy & immunology practice. We'll show you where revenue is leaking and how to fix it.