Allergy Testing & Immunotherapy Billing: Key Guidelines in 2025

Allergy and immunotherapy billing remains one of the most intricate areas of medical billing in 2025. From complex dose calculations and multi-visit therapy regimens to ever-changing CPT/ICD-10 codes and payer-specific requirements, allergists, specialists, and billing professionals face a unique set of challenges. Even a small oversight in documentation or bundling can result in denied claims and lost revenue.

What makes it even more critical is the shift toward value-based care and digitally driven revenue cycles. Accuracy is mandatory in the anesthesia billing landscape. The good news? The rise of AI-driven solutions and billing partners like MaxRemind is making the entire process more manageable and compliant. By combining specialty-focused human oversight with intelligent automation, practices are now reclaiming revenue that would have been lost to errors.

Even more challenging is the fact that coding errors often go unnoticed until a denial comes back or the clinic undergoes an audit. At that point, it’s a race to correct the issue, resubmit the claim, and hope it’s not too late to recover the payment.

CPT Codes for Allergy Testing and Immunotherapy

To navigate allergy billing successfully, practices must be proficient in the correct use of CPT codes. These codes are the core of your billing process. They also determine how much you get reimbursed and how prone you are to denials or audits.

Here are the essential CPT codes for allergy services in 2025:

Codes	Description
95004	Percutaneous (prick) skin testing, used for initial allergen sensitivity evaluations
95024	Intradermal testing, typically done following a negative skin prick
95115	A single injection of allergenic extract (without supervision)
95117	Multiple injections of allergenic extract (same day)
95165	Professional preparation and supply of allergen extract, per dose

Each of these codes comes with its documentation requirements. For example, 95165 should reflect each dose mixed, with precise allergen content and quantity logged. Billing for 95024 without first performing 95004 (or lacking justification) could raise compliance flags.

Moreover, certain insurers may demand supporting documentation, such as time logs, physician orders, and treatment plans. This is especially common for maintenance-phase immunotherapy or custom-mixed vials.

Common Allergy Billing Mistakes That Cost You Revenue

Allergy testing and immunotherapy services offer significant revenue potential, but only if billing is done correctly. Unfortunately, billing errors in this specialty are still widespread and often go undetected until it’s too late.

Here are the most common and costly errors allergy clinics make:

Bundling tests incorrectly, especially when billing skin prick and intradermal tests on the same date of service without separate justification
Using unlisted or unapproved allergens can lead to claim denials or compliance penalties
Missing required documentation for custom extract vials (billing 95165 without proper dosage log)
Overlooking time logs when billing for multiple allergy injections in one session
Incorrect frequency of billing, particularly with maintenance therapy (e.g., billing sooner than payers allow)

READ HERE: Common Medical Billing and Coding Errors and How to Avoid Them

These errors are more than just compliance issues — they have a direct effect on your profitability. They can trigger claim rejections, delays in reimbursement, and even audits. Worse, many clinics don’t realize they’re underbilling or missing revenue entirely.

How AI Is Reshaping Allergy Billing

The future of allergy billing is now being shaped by artificial intelligence. There are so many variables to keep track of, like modifiers, frequency rules, dose tracking, and diagnosis code pairing. Manual systems just can’t stay on top of it all. That’s why more and more practices are adopting AI-powered billing platforms to ensure accuracy, improve compliance, and speed up revenue cycles.

Here’s how AI is transforming allergy billing today:

AI Code Suggestion & Matching

AI algorithms analyze patient symptoms, lab results, and physician notes to auto-suggest the right CPT and ICD-10 combinations, reducing the risk of errors.

Denial Prediction & Pre-Submission Audits

Using machine learning, AI systems can flag problematic claims before submission, such as missing modifiers or codes that typically trigger denials.

NLP-Driven EHR Data Extraction

Natural Language Processing (NLP) scans physician documentation in the EHR and extracts billing-ready data, eliminating the need for repetitive manual entry.

Auto Dose Tracking for Immunotherapy

AI tools track allergen extract usage and dosing schedules to ensure that every dose billed under 95165 or 95117 is compliant and supported by logs.

Smart Dashboards & Revenue Leakage Reports

AI dashboards provide real-time insights into underbilled services, unsubmitted encounters, or inconsistencies in billing behavior—helping practices recover lost revenue.

READ HERE: The Impact of AI in Medical Billing

By automating these workflows, AI not only improves billing accuracy but also reduces staff burnout, allowing front-desk teams and billers to focus on patient experience and strategic revenue growth.

How MaxRemind Supports Allergy Billing

MaxRemind is at the forefront of AI-enabled revenue cycle management for allergy clinics. Our platform is designed to meet the complex demands of immunotherapy billing. It manages everything from dose tracking and modifier use to seamless EHR data integration.

Here’s how MaxRemind delivers tangible value to allergy practices:

Specialty-Trained Billing Experts
Our team understands the specifics of allergy coding, including tricky services like allergen mixing, subcutaneous injections, and challenge tests.
AI-Powered Claim Accuracy
Our intelligent billing engine flags coding issues, recommends compliant code combinations and prevents costly denials before submission.
Real-Time Compliance Tools
Built-in alerts notify you when documentation is missing, payer rules have changed, or claim patterns suggest underbilling or misuse.
EHR & NLP Integration
We seamlessly connect with your EHR system and extract necessary billing data through Natural Language Processing, which eliminates the bottlenecks.
Custom Reporting for Performance & Revenue Insights
Get access to powerful dashboards showing missed revenue, denial trends, and provider-specific patterns.

TAKE A FREE ALLERGY PRACTICE AUDIT

Whether you’re a solo practice or a multi-location allergy group, MaxRemind offers the tools and support you need to thrive in the modern billing environment.

Revenue Success Lies in Accuracy

The reality in 2025 is clear: billing success in allergy testing and immunotherapy isn’t just about knowing the codes – it’s about using them correctly and consistently. With payer scrutiny increasing and billing complexity at an all-time high, relying solely on manual processes is no longer sustainable.

By pairing updated billing knowledge with AI-powered tools and partnering with experts like MaxRemind, allergy practices can finally overcome the recurring hurdles of denials, underbilling, and documentation gaps.

Looking to improve your billing outcomes and recover lost revenue?

Schedule a free consultation or start your free trial today.

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FAQs

What are the updated CPT codes for allergy testing in 2025?: The core codes remain 95004, 95024, 95115, 95117, and 95165—but documentation and payer rules have become more stringent, especially around allergen preparation and dosage logging.
How should I bill for allergy shots and vial mixing?: Use 95115 or 95117 for injections, and 95165 for allergen preparation. Make sure to log doses, ingredients, and time/date of service accurately.
Can AI improve allergy billing accuracy?: Yes. AI automates code pairing, detects billing errors, tracks dosages, and extracts billable data from your EHR—reducing human error and denials.
What are the top mistakes to avoid in allergy billing?: Bundling errors, billing unapproved allergens, missing dose documentation, and violating payer-specific rules on frequency or consent.
Does MaxRemind offer allergy-specific billing solutions?: Absolutely. MaxRemind offers end-to-end billing services for allergists, backed by AI technology, compliance tools, and customized reporting.