Allergy & immunology has quietly become one of the most revenue-sensitive specialties in the U.S. While patient volumes continue to climb driven by rising environmental allergens, chronic asthma, food sensitivities, and immune-related disorders reimbursement is not keeping pace. What many clinics don’t realize is that the same clinical growth fueling their schedules is also increasing their billing risk.
In 2025, payers are tightening rules for allergy testing, immunotherapy, biologics, and long-term respiratory care. Even small coding or documentation gaps can lead to cascading denials, delayed cash flow, or payer audits. For practices already dealing with heavy patient loads, this financial pressure is unsustainable.
This guide unpacks the challenges, trends, and revenue traps shaping allergy & immunology billing today and how Health Quest Billing helps practices stay profitable, compliant, and audit-ready.
Why Allergy & Immunology Billing Is More Difficult Than Ever in 2025
Allergy & immunology billing is not like standard outpatient billing. It is multi-component, high-volume, and deeply payer-regulated, which makes it far more vulnerable to errors.
1. Multi-Step Testing Requires Precision
Skin tests, patch tests, intradermal tests, food challenges, and spirometry each require:
- Distinct CPT codes
- Correct unit tracking
- Side-specific documentation
- Lot numbers & dilution details
One missing element = an instant denial.
2. Immunotherapy Billing Is Highly Technical
Each step of immunotherapy must be billed separately:
- Antigen preparation
- Antigen mixing
- Single vs. multiple injection days
- Dose changes
- Multi-vial regimens
Most denials occur when clinics incorrectly bill 95115, 95117, or antigen prep codes (95144–95170).
3. Payer Rules Evolve Constantly
Medicare, Medicaid, and commercial plans all publish different rules for:
- Allergy testing coverage
- Medical necessity
- Required documentation
- Prior authorizations
- Component-based billing
Missing just one update can disrupt weeks of revenue.
4. Immunotherapy & Respiratory Claims Face the Highest Scrutiny
Payers now flag:
- Incorrect modifiers
- Unbundled charges
- Overbilled antigen doses
- Missing consent & treatment plans
This is why allergy & immunology claims average some of the highest denial rates among outpatient specialties.
Key U.S. Trends in Allergy & Immunology and What They Mean for Your Practice
As allergy and immunology services continue to grow, especially in states with high allergy rates, billing and coding for these services is becoming increasingly important. Some key trends to note:
Rising Allergy & Immunology Volume:
- Asthma: Affects over 26 million people in the U.S., with the highest rates in states like Texas, Georgia, and Florida.
- Food Sensitivities & Allergies: Affects millions, creating a surge in diagnostic testing and immunotherapy treatments.
- Seasonal Allergies: Affects approximately 25.7% of adults, driving increased office visits and testing services.
States with High Allergy/Immunology Visit Volume:
- Texas, Florida, California, New York, Arizona, and Georgia report the highest patient volumes, immunotherapy treatments, and billing complexities, increasing the risk of errors and denials in these areas.
Given the rising demand, practices in these states must ensure their billing processes are both efficient and compliant to avoid revenue leakage.
Hidden Revenue Leaks in Allergy & Immunology Practices
Below are the issues responsible for 60%+ of lost reimbursement in allergy & immunology:
1. Incorrect Immunotherapy Billing
Medicare requires component-based billing.
Commercial payers often follow different rules.
Confusing them leads to audit risk.
2. Overbilling Antigen Doses
Many clinics incorrectly report “dose” amounts.
Most payers define 1 cc = 1 billable unit, regardless of how much extract is actually administered.
3. Wrong Use of Injection Codes
You must not bill:
- 95115 (single injection)
and
- 95117 (multiple injections)
on the same date of service.
Payers flag this instantly.
4. Missing Proof of Medical Necessity
Payers require:
- Patient symptoms
- Past conservative therapies
- Allergen exposure history
- Dosing schedules
- Ongoing monitoring notes
Missing ANY of the above leads to denials.
5. Prior Authorization Gaps
Many allergy tests and immunotherapy services require pre-approval.
Missing authorizations = automatic denial.
Essential CPT Codes for Allergy & Immunology Billing
| Category | CPT Code(s) | Description |
| Allergy Testing | 95004–95078 | Skin, patch, intradermal & challenge tests |
| Antigen Preparation | 95144–95170 | Allergen extract prep & mixing |
| Immunotherapy Injections | 95115 | Single injection |
| 95117 | Multiple injections | |
| Spirometry | 94010 | Breathing capacity test |
| Respiratory Function | 94640 | Airway inhalation treatment |
| Biologics Administration | 96372 | Therapeutic injection |
How Health Quest Billing Ensures Allergy & Immunology Practices Stay Profitable
Health Quest Billing provides specialty-focused RCM designed for A/I practices, helping clinics avoid common revenue pitfalls.
Coding Expertise for Allergy & Immunology
Our coders understand:
- Component-based billing
- Antigen prep guidelines
- Dose-specific payer rules
- Multi-vial immunotherapy billing
- Annual coverage updates
Documentation & Medical Necessity Support
We help practices maintain payer-ready documents, such as:
- Treatment plans
- Allergen testing results
- Patient consent
- Dose escalation logs
- Monitoring notes
Denial Prevention & A/R Recovery
Our billing system flags:
- Coding conflicts
- Missing modifiers
- Unbundled charges
- Payer-specific errors
This ensures clean claim submission and reduces A/R days.
Prior Authorization Management
Health Quest handles:
- Eligibility verification
- PA submissions
- Follow-ups
- Renewal alerts
State-Level Payer Compliance
We continuously track payer changes in:
- Texas
- Florida
- California
- New York
Clinics stay ahead of policy changes without extra work.
Why 2025 Is Critical for Allergy & Immunology Billing
Allergy & immunology billing has become more complex due to:
- Increased payer audits
- Frequent code changes
- Higher PA requirements
- Stricter LCDs and medical necessity rules
Without expert billing support, practices risk revenue leakage, compliance issues, and slower cash flow.
Conclusion: Optimize Your Allergy & Immunology RCM with Health Quest Billing
Health Quest Billing provides end-to-end support, from coding accuracy to documentation, denials, payer rules, and RCM process optimization.
We help your practice:
- Minimize denials
- Capture all billable revenue
- Stay compliant
- Improve cash flow
- Scale efficiently
If your allergy & immunology program is expanding, Health Quest Billing ensures your revenue grows alongside it without billing headaches or financial risks.
