Immunology is a complex medical specialty focused on diagnosing and treating conditions related to the immune system — including allergies, asthma, autoimmune disorders, immunodeficiencies, and inflammatory diseases. Immunologists often conduct extensive diagnostic testing, use high-cost biologics, and manage long-term treatment plans.

With services ranging from allergy testing and immunotherapy to rheumatologic screenings and advanced lab diagnostics, immunology billing is both detailed and dynamic. Accurate coding, proper modifier use, and awareness of payer-specific guidelines are essential to avoid denials and ensure timely reimbursements.

At Progressive RCM, we provide comprehensive immunology billing services that support practices in delivering expert care while maintaining a healthy revenue cycle.

---

Challenges in Immunology Medical Billing

1. Complex Testing and Lab Billing

Immunologists frequently order or perform tests such as:

• Allergy panels (skin or serum)

• Autoantibody screens

• ANA, ESR, CRP

• Rheumatoid factor tests

• T-Cell and B-cell counts

These tests involve multiple CPT codes, frequent bundling issues, and payer scrutiny for medical necessity.

2. Biologics and Injectable Drug Billing

Treatments often include biologic therapies (e.g., omalizumab, dupilumab, adalimumab) for asthma, rheumatoid arthritis, or lupus. Billing these requires:

• Correct J-code assignment

• Unit-based calculations

• Waste reporting (JW modifier)

• Prior authorization compliance

3. In-Office Allergy Testing & Immunotherapy

Immunologists often provide:

• Skin prick testing

• Intradermal testing

• Allergen extract preparation

• Immunotherapy administration (SCIT)

Billing must distinguish between testing, mixing, and injection codes — and correctly apply modifiers and dosage units.

4. Autoimmune Disorder Management

For chronic diseases like lupus, rheumatoid arthritis, or celiac disease, immunologists may bill E/M visits, long-term care management, or infusion therapy, all requiring accurate code linkage.

5. Medical Necessity and Payer Policies

Many insurers require clear clinical documentation and diagnosis support for immunology testing and biologic prescriptions. Errors in documentation can lead to claim denials or audits.

---

Common CPT, HCPCS, and ICD-10 Codes in Immunology

✅ CPT Codes:

• 95004 – Percutaneous allergy skin testing

• 95024 – Intradermal allergy testing

• 95165 – Allergen extract preparation

• 95115 – Single injection immunotherapy

• 95117 – Multiple injection immunotherapy

• 86003 – Allergen-specific IgE (serum)

• 86141 – Antinuclear antibody (ANA)

• 82784 – IgE level

• 96372 – Therapeutic injection

✅ HCPCS (J-Codes):

• J2357 – Omalizumab (Xolair)

• J0129 – Abatacept

• J0597 – C1 esterase inhibitor

• J0585 – Botulinum toxin for immune conditions

• J1745 – Infliximab

✅ ICD-10 Codes:

• J45.40 – Moderate persistent asthma

• D80.0 – Hereditary hypogammaglobulinemia

• M06.9 – Rheumatoid arthritis, unspecified

• L50.0 – Allergic urticaria

• K90.0 – Celiac disease

• D89.9 – Immune disorder, unspecified

• M32.9 – Systemic lupus erythematosus

---

Immunology Services That Require Detailed Billing

• Allergy skin and serum testing

• Allergen extract mixing and immunotherapy

• Biologic drug infusion or injection

• Chronic autoimmune disease management

• IgG, IgE, and immunoglobulin testing

• Genetic and molecular testing

• E/M visits linked to diagnostic testing

• Remote patient monitoring for chronic immune conditions

---

Our Immunology Billing Services

At Progressive RCM, we understand the intricacies of billing in immunology. We ensure every visit, test, and treatment is coded accurately and reimbursed appropriately.

✅ Patient Insurance Verification

• Confirm eligibility and benefits

• Verify prior authorization requirements for biologics and labs

• Check deductible and copay amounts

✅ Accurate Coding and Modifier Use

• Assign correct CPT, ICD-10, and J-codes

• Apply modifiers (25, 59, JW) as required

• Use code bundling knowledge to avoid denials

✅ Claim Submission & Revenue Management

• Submit clean claims within 24–48 hours

• Interface with your EMR and lab systems

• Track and post EOBs and ERAs quickly

✅ Drug Unit Billing and Compliance

• Calculate units for injectables based on dosage

• Report unused medication with JW modifier

• Align with Medicare and commercial payer guidelines

✅ Denial Management and Appeals

• Monitor rejection reasons (documentation, invalid code, coverage limits)

• File appeals with supporting clinical records

• Track denials by payer and CPT code for proactive improvement

✅ Patient Support and Statements

• Generate clear and easy-to-understand bills

• Educate patients about copays, coverage, and services not covered

• Offer payment plans for high-cost biologics or labs

✅ Reporting and Analytics

• Revenue by provider, procedure, and payer

• AR aging reports

• Top denial reasons and resolutions

• Drug reimbursement tracking

---

Why Choose Progressive RCM for Immunology Billing?

✅ Allergy & Autoimmune Expertise
Our billers understand the nuances of skin testing, allergen mixing, and chronic care billing.

✅ Biologic Drug Billing Specialists
We handle J-code accuracy, unit tracking, and waste reporting, helping you get paid for every vial and dose.

✅ Seamless Integration with EHR Systems
We integrate with systems like Allscripts, eClinicalWorks, Athenahealth, Kareo, and custom platforms.

✅ Compliance with Lab and Drug Billing
From IgG testing to infusion therapy, we ensure all documentation aligns with CMS and private payer guidelines.

✅ Higher Reimbursements, Lower Denials
Our team proactively manages documentation, authorizations, and coding accuracy to optimize collections and reduce rejections.

---

KPIs We Monitor for Immunology Practices

• Clean claim submission rate

• First-pass acceptance percentage

• Drug reimbursement vs. drug cost tracking

• Denial rate by CPT code

• Average revenue per encounter

• Charge lag and payment posting times

---

SEO Keywords Used:

• immunology medical billing services

• allergy testing CPT codes

• billing for autoimmune diseases

• J-codes for biologic injections

• immunotherapy billing and coding

• ANA and IgE testing billing

• Medicare billing for immunology

• chronic care coding in immunology

• allergy extract billing

• revenue cycle for immunology specialists

---

Final Thoughts

Immunology billing isn’t just about submitting claims — it’s about understanding the science behind the service. From allergy testing and autoimmune diagnostics to biologic therapies, each service must be billed with expertise and precision.

At Progressive RCM, we combine billing knowledge with a deep understanding of immunology care, helping your practice maintain healthy revenue while delivering exceptional care.