Allergy & Immunology
Allergy and immunology practices face unique billing challenges due to specialized testing procedures, biologic therapies, and insurance complexities. Proper documentation, accurate coding, and compliance with payer regulations are essential to ensure timely payments. At Malakos Healthcare Solutions, we help allergy and immunology providers streamline their revenue cycle and reduce claim denials.
Common Challenges in Allergy & Immunology Billing
1. Complex Allergy Testing & Injection Coding
- Billing for skin prick tests (CPT 95004), intradermal tests (95024, 95027), and patch testing (95044) requires precise coding.
- Allergy immunotherapy (95115-95199) must be properly documented to justify medical necessity.
2. Frequent Prior Authorizations
- Many biologic treatments (e.g., Xolair, Dupixent) require prior authorization.
- Failure to get approvals leads to denied claims and payment delays.
3. Insurance Variability for Immunotherapy
- Some payers limit coverage for allergy shots and biologic therapies.
- Medicare & Medicaid have specific guidelines on the frequency of covered treatments.
4. Denials Due to Incorrect Modifiers
- Using modifiers (-25, -59, -76) correctly is crucial for ensuring proper reimbursement.
- Modifier -25 is often needed when an E/M visit is billed with an allergy test.
Best Practices for Allergy & Immunology Billing Success
1.Use Correct CPT & ICD-10 Codes
- Document conditions properly with ICD-10 codes like J30.1 (Allergic rhinitis due to pollen) or Z91.01 (Allergy to peanuts).
- Apply the right CPT codes for allergy testing, immunotherapy, and biologic injections.
2.Verify Insurance & Obtain Prior Authorizations
- Confirm patient eligibility before performing procedures.
- Submit pre-authorizations for specialty medications and high-cost treatments.
3. Optimize Documentation & Modifiers
- Ensure proper coding for multiple procedures performed on the same day.
- Use modifier -59 for separate procedures and modifier -25 when billing an E/M visit with testing.
4. Stay Updated on Payer Policies
- Insurance coverage for biologic therapies and allergy testing changes frequently.
- Work with a billing partner to ensure compliance with updated guidelines.
How Malakos Healthcare Solutions Can Help
At Malakos Healthcare Solutions, we specialize in:
- Allergy & Immunology Billing – Accurate coding for tests, immunotherapy, and biologics.
- Insurance Verification & Prior Authorizations – Ensuring coverage before treatments.
- Denial Management & Appeals – Reducing claim denials and maximizing reimbursements.
- End-to-End RCM Support – From claim submission to payment posting.