Skip to content Credex Healthcare delivers immunology billing services for allergists, clinical immunologists, and allergy-immunotherapy practices, addressing allergy-testing claim denials, immunotherapy injection billing errors, and prior-authorization gaps for biologic treatments for severe asthma, allergic rhinitis, and immune deficiency disorders.
Our immunology billing specialists know those distinctions and apply them on every claim, including percutaneous and intradermal allergy skin testing, allergen immunotherapy injection billing, and specialty biologic drug administration, each of which follows completely different CPT code sets, documentation requirements, and payer coverage rules.
First-pass claim approval rate
Average immunology billing turnaround
Medicare, Medicaid & commercial networks
Biologic prior authorization & immunotherapy documentation
Credex Healthcare runs a dedicated immunology billing process that checks every claim against the treating provider’s documentation, the payer’s coverage rules for that specific service, and any prior authorization requirement before submission. Allergy testing billing codes carry specific documentation requirements around the number of tests performed, the allergens tested, and the reaction grading that supports medical necessity. Immunotherapy injection billing requires that the allergen extract preparation be documented separately from the injection administration. Immunology billing errors and fixes are expensive in this specialty because service volume is high, and recurring errors multiply across hundreds of test and injection visits each month.
Our immunology billing services in the USA cover the following:
Claims go out with verified CPT codes, correct allergen test counts, immunotherapy preparation and injection codes separated correctly, and biologic drug prior authorization on file. Our team tracks adjudication in real time and follows up before timely filing windows close.
We manage provider enrollment for allergists, immunologists, and APPs with Medicare, Medicaid, and commercial carriers, reducing the gap between a provider joining your practice and billing from their first patient appointment.
Denied claims are reviewed within 48 hours. Whether the rejection came from an allergy test count limit, a missing immunotherapy extract preparation code, a biologic prior authorization gap, or a medical necessity dispute, our team corrects it and resubmits with the documentation that the specific payer requires.
Our certified coders audit encounter records against allergy testing billing codes 95004, 95024, immunotherapy codes 95115 and 95117, and the full immunology CPT and HCPCS code set, confirming test counts, injection documentation, and biologic administration records match what is billed.
Biologic therapies for allergic asthma, chronic rhinosinusitis with nasal polyps, atopic dermatitis, and eosinophilic esophagitis require prior authorization with step-therapy documentation from most commercial payers. We initiate, track, and document authorizations before any biologic is administered.
End-to-end RCM covers eligibility verification, allergy testing and immunotherapy charge capture, biologic drug administration billing, payment posting, and monthly reporting so practice administrators have accurate collections data by service type and payer each billing cycle.
As a dedicated immunology billing company in USA, Credex Healthcare tracks Medicare Local Coverage Determinations for allergy testing, monitors commercial payer prior authorization requirement changes for biologic agents used in immunology practice, and maintains current billing standards for allergen immunotherapy, allergy skin testing, and biologic injection administration. Medicare coverage for allergy testing depends on the number of tests billed and whether the testing was preceded by a relevant history and physical that supports the medical necessity of the specific allergens tested. For biologic therapies, step therapy requirements and clinical criteria differ by drug and by payer, and those requirements change frequently enough that a billing team not actively tracking them will have authorization denials every cycle.
Medicare covers allergy testing and immunotherapy when medical necessity is documented, and the number of tests billed matches the clinical record. We manage Medicare immunology billing across all MAC jurisdictions, applying correct test count limits, immunotherapy billing rules, and biologic drug billing under the appropriate J-codes.
Medicaid coverage for allergy testing, immunotherapy, and biologic agents varies significantly by state. Some state programs require prior authorization for standard allergy testing panels. Our team maintains state-specific Medicaid immunology billing rules and applies them correctly to every claim.
Biologics used in immunology practice, including dupilumab, omalizumab, benralizumab, and mepolizumab, are billed using specific HCPCS J-codes alongside the drug administration CPT code. We manage biologic billing as a separate workflow, with built-in prior authorization tracking, step therapy compliance review, and J-code accuracy.
For allergy practices with multiple physicians and APPs providing testing, immunotherapy, and biologic services, we coordinate provider-level billing, incident-to service rules for APP encounters, and group NPI configuration so all providers’ claims go out under the correct credentials.
Immunology claims need to be paid for the correct number of allergy tests performed. Also, vaccine preparation codes and syringe codes should be kept separate, and prior authorizations for biologics should be gotten before they are given. Before any claim is sent in, Credex Healthcare looks over all of them.
Every allergy and immunology APP in your practice is verified to make sure they are currently credentialed, enrolled with all payers, and in the right specialty group before claims are sent under their provider number.
Our team checks allergy testing records against CPT codes 95004 (percutaneous tests) and 95024 (intradermal tests, sequential), making sure that the claimed diagnosis is supported by the allergen panel tests and that the number of units billed matches the number of tests recorded in the contact record.
CPT 95115 covers allergy immunotherapy injections that do not require preparation with an extract. CPT 95117 covers at least two shots that don't need to be prepared. When paying for extract processing, CPT codes 95144 through 95180 are used, based on the type of extract. For each treatment visit, we make sure that the right mix of preparation and shot numbers is used.
Prior authorization for immune biologics is tracked for each patient and supplier, and step-treatment compliance records are kept. Authorization update dates are compared with each patient's treatment plan to make sure that no dose is given without the current funder approval on file.
Each private insurance company and Medicare MAC has its own rules about which allergy tests can be performed, how biologic step treatment works, and when immunotherapy is covered. We keep up-to-date payment guides for all insurance companies on your practice panel and ensure that each claim follows the appropriate rules when it is sent in.
Accounts Receivable Follow-Up
Immunology AR is reviewed once a week. Unpaid claims are investigated before the deadline for filing them on time passes. It is easier to settle disagreements about allergy test counts and biologic underpayments when there is clinical evidence and a negotiated rate to support the original billing.
Immunology practices lose revenue due to billing patterns that repeat visit after visit. Allergy skin tests were performed and documented, but 58 units were billed because the charge capture template defaulted to a lower number. Immunotherapy visits in which the extract preparation code was omitted because the biller did not know it was billable separately from the injection. Biologic prior authorizations obtained but never renewed, resulting in the next quarterly dose being denied after the patient has already received it. Credex Healthcare’s immunology billing process catches all three at the charge entry stage.
End-to-end immunology insurance billing from charge capture and allergy test count verification through allergen immunotherapy and biologic code assignment and electronic submission to Medicare, Medicaid, and commercial payers for every encounter.
Our immunology billing specialists apply the correct allergy and immunotherapy billing codes with accurate test counts, preparation, and injection code separation, and biologic J-codes every time, cutting the denials from immunology documentation requirement errors.
Prior Authorization Management
Prior authorization for immunotherapy biologics is tracked from initial request through step-therapy approval and renewal. No biologic dose is administered without current authorization on file, and renewals are initiated before the prior approval period expires.
Denial management for immunology claims covers allergy test count disputes, immunotherapy code combination corrections, biologic step-therapy documentation appeals, and medical-necessity challenges. Each appeal is built around the clinical record and payer policy that reverses the denial.
Provider application management covers initial enrollment for allergists and APPs, incident-to billing setup, group NPI configuration, and ongoing recredentialing so your practice bills without interruption as payer agreements renew or new providers join.
Monthly reports cover collections by service type and payer, allergy testing billing accuracy by test count, immunotherapy injection billing performance, biologic drug administration revenue, denial trends by CPT code, immunology billing turnaround time, and AR aging.
Years of Immunology Billing Expertise
Provider Enrollment & Credentialing Success
Claim Compliance Rate Across All Payer
Support Available for All Your Needs
Customized Immunology Revenue Cycle Solutions
MD
Areesha
“Our allergy skin testing billing has been using a flat 40-unit count for every full panel test, even though our nurses were documenting between 50 and 70 tests per patient, depending on the panel. Credex audited three months of testing records against the billed units and found the underbilling pattern immediately. They corrected the charge capture template to pull the actual test count from nursing documentation, and testing revenue per encounter went up noticeably. We had been undercharging every allergy test for over two years.”
Practice Manager
Mensah
“Biologic prior authorization for dupilumab and omalizumab across 300 active patients was an unmanaged process before Credex. Some patients were receiving doses on expired authorizations, and we did not know until the EOB came back, denied. Credex built a per-patient biologic-tracking calendar, set up alerts 30 days before each PA expiration, and documented the step-therapy records for each commercial carrier. Biologic denial rate went from around 14% to under 3% in the first quarter.”
MD
Chinonso
“Pediatric allergy billing involves lower test count thresholds on some commercial plans and specific documentation requirements for pediatric immunotherapy safety protocols. My previous billing company applied adult immunotherapy billing rules to all patients regardless of age, and we had recurring denials on pediatric injection claims. Credex separated the billing by age group and payer, and the pediatric immunotherapy denial rate dropped significantly within the first two months.”
Revenue Cycle Director
Kolade
“We have four allergists, two APPs, and an in-house pharmacy providing biologic injections. The extract preparation billing had never been set up correctly, and we were billing the injection codes without the preparation codes on every immunotherapy visit. Nobody had caught it because the injection claims were paying. Credex audited the immunotherapy billing history, identified the missing preparation code pattern going back 18 months, filed corrected claims for the recoverable period, and fixed the charge entry template. That recovery was a meaningful sum.”
MD
Odesa
“Clinical immunology billing covers immune deficiency treatment, IVIG administration, and tolerance protocols that most billing companies do not know how to code. IVIG billing requires both the J-code for the drug and the infusion administration codes, with the correct drug dosage documented in milligrams per kilogram. Credex had people who understood the IVIG billing workflow from day one. Our first-pass approval rate on IVIG claims went from 61% to 92% after the transition.”
Practice Assessment
We audit your current immunology billing workflow, allergy testing charge-capture accuracy, immunotherapy preparation and injection code separation, biologic prior-authorization tracking status, AR aging by service type and payer, and denial history by CPT code. This shows exactly where revenue is falling short, and which billing errors need to be corrected first.
Credentialing & Payer Enrollment
Every allergist and immunology APP is verified for active enrollment with each payer, correct specialty taxonomy, and incident-to billing setup for APP encounters. Any provider application management gaps are resolved before new claims are submitted.
Prior Authorization Setup
We identify every biologic therapy and specialty procedure in your patient panel that requires prior authorization by payer, build a patient-level tracking system with step-therapy documentation, and confirm authorization status before each treatment cycle begins.
Clean Claim Submission
Our immunology billing specialists review the encounter paperwork, make sure the number of allergy tests is correct, verify that the immunotherapy preparation and injection codes are correctly separated, use the appropriate biologic J-codes, and send claims electronically to Medicare, Medicaid, and commercial payers for every encounter.
Denial Management & Follow-Up
Every claim is tracked through adjudication. Within 48 hours, denials are looked over again. Disputes about allergy test counts, changes to immunotherapy code combinations, and requests for biologic step treatment all get a specific answer based on the patient's medical record and the payer's rules.
Reporting & Ongoing Optimization
Each month, reports are generated showing how much money was collected by service type and customer, how well allergy tests were billed, how well immunotherapy injections worked, how much money was made from biotech drugs, how long it took to bill for immunology services, and how old the accounts receivable were. At the charge-capture level, recurring mistakes are fixed.
Immunology billing includes allergy skin tests, allergen immunotherapy, biologic drug administration, clinical immunology treatments, and IVIG infusion therapy. Each of these has its own set of rules for paperwork, CPT codes, and payers. There is only one way for a general billing company to handle all of them, and the rate of denials shows it. When it comes to medical billing, Credex Healthcare focuses on immunology because this field requires billing experts who understand the difference between invasive and intradermal tests and how the preparation and injection code split works in real life.
Our team works on allergy and immunology claims daily. We understand how to use billing codes for allergy tests based on test type and count, how to prepare for immunotherapy and give injections, how biologic J-codes work with administration codes, and where immunology billing mistakes most often occur in the testing, injection, and drug administration workflows.
There is one immunology billing expert who works only for your practice. This person knows all of your services, your biologic panel, your payer contracts, and the trends of claims that keep getting denied.
Monthly reports show the real financial state of the business. They show payments by service type and payer, allergy testing billing accuracy by test count, immunotherapy shot performance, biologic drug income, reject trends, and immunology billing response time.
Full HIPAA compliance procedures protect patient allergy records, test results, and biologic treatment records that are handled during the payment process. Every system that handles claims for your business follows strict security rules and allows only certain people to access it.
Immunology practices lose revenue due to billing patterns invisible until someone audits charge capture. Allergy tests were documented as 65 units but billed as 40 because the template defaulted to a fixed count. Immunotherapy visits where the extract preparation code was never added because no one set it up in the billing system. Biologic doses were administered on expired authorizations for months before the denials accumulated into a noticeable AR problem. These are fixable. An audit finds them in the first few weeks.
Credex Healthcare begins with a free review of your present immunology billing. This review includes an allergy test count accuracy check, an immunotherapy code split review, a biologic prior authorization tracking status, an aging of the account by service type, and a decline history by CPT code. You don’t have to make a promise to get that rating. We figure out what your practice is losing and how much money it could recover by improving the process.
Immunology billing is the process of getting paid for allergy and clinical immunology services, such as allergy skin tests, allergen immunotherapy, biologic drug administration, and treatment for immune weakness. In most practices, immunology billing is split into three separate areas: allergy testing, which has procedure-specific codes for each test type and needs documented test counts; allergen immunotherapy, which bills for both extract preparation and injections; and biologic drug administration, which pairs an HCPCS J-code for the drug with a drug administration CPT code.
CPT codes are used for allergy tests, treatments, and drug administration in immunology bills. CPT 95004 covers tests performed on the skin, such as stick and scratch tests, and is charged per test. CPT 95024 covers allergy tests applied to the skin with a single dose. One allergy immunotherapy shot is covered by CPT 95115, but no extract is given. It is covered by CPT 95117 for two or more doses without extract. The extract preparation codes range from 95144 to 95180 and depend on the type of extract and the number of doses prepared.
Yes, Medicare Part B, Medicaid, and private health plans all cover allergy and immunology treatments that are medically necessary. Medicare pays for allergy skin tests if the clinical documentation supports the number of tests paid, and the diagnosis supports the testing suggested. Biologic drugs used to treat allergic conditions are covered by Part B if they are injected in the office and meet certain medical-necessity standards, such as having failed step therapy in most cases.
When test counts are correct and medical necessity is demonstrated, Medicare handles clean electronic immune claims in 14 to 30 days. When past authorizations are still valid, and allergy tests and treatment codes are used properly, commercial payers usually pay within 30 days. When Medicaid applications are due varies by state, but they are usually 30 to 60 days. All three are reviewed by Credex Healthcare’s pre-submission review before claims are sent in. This makes sure that most immunology claims are processed within the normal timeframe for billing immunology.
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