CPT Codes for Primary Care Allergy Testing and Treatment: Physician & Owner’s Overview
First, trust your billing experts, not the interwebs. This guide is a high-level abstract intended for primary care clinic owners and managers to help convey the broad contours of reimbursement for allergy testing and treatment. The takeaway is that billing and reimbursement are straightforward and highly lucrative in nearly all situations, using a small set of readily understood codes.
Also note that CPT, for Current Procedural Terminology, is a registered trademark of the American Medical Association. MRS Allergy makes no claim to that mark, but because of billing arrangements necessitated by the American healthcare system, clearly describing billing procedures makes using that term unavoidable.
In a well-run, comprehensive allergy testing and treatment program, the process for the patient typically starts with an ordinary visit that isn’t about allergy. This is crucial. You’ll see us repeat it a lot, but a proper allergy program treats allergy similarly to hypertension: screen for it because otherwise you greatly reduce the chances of detecting a medical need. Thus, consistent with the standard, best practice advice that allergies are diagnosed through a combination of medical history and testing, new patients arrive for their initial intake and take an allergy symptom survey along with providing the rest of their medical history. Existing patients arrive for their first visits since the allergy program was established and augment their medical history by taking that survey. All patients then retake that survey annually, unless they’ve already had a positive survey, in which case they’re reminded that they need a test, or have tested positive and have been moved into a treatment protocol, starting with recommended treatment.
Once the survey establishes medical necessity for allergy testing, the protocol and billing goes:
- Allergy skin test, CPT code 95004. If the test is positive, then:
- Allergen serum for treatment, CPT code 95165. If the treatment is shots, SCIT, subcutaneous immunotherapy, then:
- Injections, CPT codes 95115 / 95117.
Using these codes in conjunction with others, such as visit codes and modifiers, is worth a discussion with your billing experts. We’ve provided some of the actual EOBs customers shared with us for your perusal. The CMS view of the world is detailed in its billing and coding guidelines on Allergy Testing and Allergy Immunotherapy.
CPT Code 95004: Percutaneous Skin Test With Allergen Extracts
A positive allergy symptom survey leads to allergy skin testing. CMS guidelines refer to that as “percut” or, lately, “perq” tests, meaning percutaneous, with allergenic extracts. It’s a skin prick test, shown in this 90-second video. As the CMS guidelines state, “The unit of service to report is the number of separate tests.” In practice, that means billing as many units as allergens tested, and potentially controls. For a standard 80-panel test, there are 78 allergens and two controls. Other testing techniques may include testing alternate dilutions of allergens, which would qualify as separate tests, again per allergen.
Whether to bill for controls, so in an 80 panel, all 80 applications to the skin, is an interesting question. The AAAAI says “it is best to check with the individual plans.” Historically, at least, commercial payors generally included controls as “tests,” as seen in actual EOBs, with some variation by payor and/or plan. Certainly without controls, the test is compromised. On the other hand, according to the AAAAI, “control tests are not separately billable because they are already included in the medical supply direct input costs for CPT 95004.” So in that sense, they’re billed already. Consult your billing expert and resources such as Availity.com for payor/plan specifics, especially in light of A57473 R5 in 2022.
CPT Code 95165: Preparation of Allergy Extracts
Skin testing, where positive, leads to a recommendation for treatment, which has two modalities, shots and drops, that each require allergen or antigen serum. Importantly, the code associated with that is not for the serum itself. It’s for “antigen therapy services,” as currently styled in July 2026 in the CMS online Physician Fee Schedule, or “preparation of vials of non-venom antigen” according to Allergy Immunotherapy guideline A57472. That preparation explicitly “includes single OR multiple antigens preparation but not the administration of the injection(s),” which “should be reported in addition” to the preparation. In other words, injection is another billable code. More on that below.
Billable as Telepresent Supervision
CPT code 95165 pertains to “Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses).” It is not the preparation itself that’s billable, but rather: “The billable act is the professional service of supervising preparation,” the American Association of Professional Coders explains.
Supervision, moreover, can now be by telepresence. Many clinicians recoil at the idea of actually preparing allergy serums in their own clinics, with visions of being surrounded by beakers and flasks while wearing shop goggles and fussing with titrating pipettes. That’s not it. A modern, comprehensive, truly turnkey allergy program does not require a physician or clinical staff to prepare serums in-house. Instead, one undersung positive from the covid era is the institution of telepresent supervision of expert serum preparation. Specifically, once a patient’s test results are properly logged and converted to a custom formula designed by MRS Allergy’s medical director, that formula is prepared by our compounding pharmacy partner under clinical supervision. As is true across this site, this is not legal or billing advice, but rather a high-level overview for purposes of helping form the questions for expert advisors.
Billable Upon Preparation for the Billable Amount Prepared
Like code 95004, use of CPT code 95165 should include the number of units. “When billing code 95165” for therapy serum, the CMS guidelines state clearly that “providers should report the number of units representing the number of 1 cc doses being prepared.” That number of doses varies widely by payor and plan, but fear not. The variability is in two dimensions: maximum number of reimbursable units, and schedule on which that number is to be billed. To illustrate, one payor/plan may allow 150 units billed at 30 units per bill, one bill per month for five months, while another payor/plan may cap it at 120 units but allow it to be billed all in one go, or two.
These variations will be easily handled because one of the services any supplier of a comprehensive, truly turnkey allergy program should provide, and in this case does provide, is clear instructions for navigating that variation successfully. The clinic submits the specific payor and plan of a given patient, typically sent with the results that allow formulation of that patient’s custom serum, then receives back the specific instructions on how that particular serum should be billed for full reimbursement. The instructions resemble a superbill, and will detail how many units should be billed on what schedule.
CPT Codes 95115 and 95117: Injections
Codes 95115 and 95117 are for SCIT, subcutaneous immunotherapy, meaning allergy shots. More specifically, they cover the professional service of administering the injection(s), not the content. Why two codes? Because the first covers a single injection, and the second covers multiple injections. Counterintuitively, code 95117 is used for any number of injections other than one, but in the allergy context, while two injections in a visit is common, there’s rarely if ever any cause for more than two injections. Consequently, each code is used to the exclusion of the other, never together for a single date of service.
Why would a patient need two injections on one visit? Short of billing shenanigans, that seems a bit counterintuitive. The explanation is that some of the allergens that partially comprise allergy serums are simply incompatible with other allergens, and can’t be mixed without inviting or causing degradation of one or the other. As Daigle and Rekkerth explained in Allergy & Rhinology, some mold and insect serums naturally, beneficially, and effectively unavoidably contain proteases, which are enzymes that degrade the proteins in other extracts and expend themselves in the process, compromising the potency of both in the resulting treatment vial. Mold or fungal extracts are highest in proteases and will degrade animal extracts, weed extracts, and grass or tree pollen as well. Crucially, animal here includes cockroaches, not just cats and dogs. Degree of dilution affects the frequency of interactions between allergen molecules, influencing shelf stability accordingly, as shown in the accompanying cross-compatibility graphic. Dilution levels matter as treatment progresses from ramp up to maintenance.