2026 billing guide · Allergy
Allergy / Immunology, coded right.
Three revenue pillars: percutaneous and intradermal allergy testing (per-test billing), immunotherapy preparation and administration (95115-95170), and biologic injection management. Testing codes are billed per-test, so unit counts matter.
Workhorse code
99204
2.60 wRVU each
Top codes covered
9
Top billed codes
The codes that drive revenue in this specialty. Click any code for documentation requirements, modifiers, and pitfalls.
| Code | Description | wRVU | Total RVU | Medicare $ | |
|---|---|---|---|---|---|
| 99204 | Office o/p new mod 45 min 99204 is the default code for most new-patient outpatient encounters in primary care and outpatient subspecialty practice. Use it for a new patient with at least one of: two or more chronic problems with progression or treatment changes; one undiagnosed new problem with uncertain prognosis; prescription drug management. Common patterns: new patient establishing primary care with multiple chronic comorbidities; new endocrinology consult for poorly controlled T2DM; new cardiology consult for chest pain and an abnormal stress test result. Prescription drug management satisfies moderate risk on its own, which makes 99204 the right code for the vast majority of new-patient continuity encounters. Time-based alternative is 45 to 59 minutes of total time on the date of the encounter. | 2.60 | 5.31 | $177 | Details → |
| 99214 | Office o/p est mod 30 min 99214 is the workhorse of primary care and most outpatient subspecialties. Use it when at least one of these is true: two or more chronic problems with progression, treatment changes, or side effects; one undiagnosed new problem with uncertain prognosis; one acute illness with systemic symptoms; or prescription drug management at any complexity. Prescription drug management on its own satisfies the moderate-risk element, which is why straightforward chronic disease follow-ups with a med adjustment routinely clear the 99214 bar. Time-based alternative is 30 to 39 minutes of total time on the date of the encounter. Pick the method that supports the strongest note: encounters with prescription changes are usually cleaner under MDM; encounters with extensive counseling or care coordination are usually cleaner under time. | 1.92 | 4.06 | $136 | Details → |
| 95004 | Percutaneous allergy test (per test) Skin prick allergy testing. Billed per-test (per antigen). | 0.01 | 0.14 | $5 | Details → |
| 95024 | Intradermal allergy test (per test) Intradermal allergy testing after negative skin prick. Per-test billing. | 0.01 | 0.17 | $6 | Details → |
| 95044 | Patch test allergy (per test) Patch testing for contact dermatitis. Per-test billing. | 0.01 | 0.19 | $6 | Details → |
| 95115 | Allergen injection, single Single allergen injection. Use 95117 for 2+ injections same encounter. | 0.07 | 0.28 | $9 | Details → |
| 95117 | Allergen injection, 2 or more Two or more allergen injections at one encounter. Not per arm — per encounter. | 0.12 | 0.40 | $13 | Details → |
| 95165 | Antigen preparation, per dose Preparation of allergen extracts. Billed per dose prepared (vial × doses per vial). | 0.07 | 0.39 | $13 | Details → |
| 95180 | Rapid desensitization, per hour Inpatient or office desensitization protocol (penicillin, aspirin, biologics). | 1.00 | 1.62 | $54 | Details → |
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Educational reference, not billing or legal advice. Coverage curated, not exhaustive. Verify against payer contracts.