Insuranceexplainedbefore you arrive.
Every CPT code, copay structure, and billing timeline — laid out clearly, so the most anxious part of allergy care becomes the most straightforward.
Trusted by 2,400+ allergy patients · Updated Feb 2026
Numbers patients lose sleep over — answered.
of visits covered by major plans
Aetna, Blue Cross, United, Cigna, and Medicare
days average claim processing
From submission to EOB in your portal
surprise bills since 2021
Every charge disclosed before your appointment
Data verified quarterly · Last audit January 2026
of visits covered by major plans
Aetna, Blue Cross, United, Cigna, and Medicare
days average claim processing
From submission to EOB in your portal
surprise bills since 2021
Every charge disclosed before your appointment
Showing you the machinery,
not hiding it.
Most practices obscure the billing process. We document every step — verification call to final statement — because transparency is the only thing that actually reduces anxiety.
Before Your Visit
We call your insurer so you don't have to.
Our billing team runs a live eligibility check on your plan before scheduling. You receive a written estimate — not a guess — before you confirm your appointment.
Codes involved
Insurance Eligibility Verification
We submit a real-time EDI 270/271 transaction to confirm active coverage, deductible status, and out-of-pocket maximums. This takes 2–4 minutes and happens before we book your slot.
Prior Authorization (when required)
Allergy immunotherapy (CPT 95165) and certain skin testing panels require prior auth from Aetna and United. We submit the PA request and notify you of approval — typically within 1–3 business days.
Written Cost Estimate
You receive a plain-language estimate showing your expected copay, coinsurance, and any deductible amounts. No surprises. If your plan changes, we re-verify.
During Your Visit
Every code entered in real time.
Our front desk enters diagnosis and procedure codes as your visit unfolds. You'll see exactly which services were rendered before you leave the building.
Codes involved
Real-Time Code Entry
Diagnosis codes (ICD-10) and procedure codes (CPT) are entered during your visit — not reconstructed afterward. This reduces claim rejection rates from an industry average of 11% to under 2%.
Allergy Testing Documentation
Skin prick tests (CPT 95004), intradermal tests (CPT 95024), and patch tests (CPT 95044) are documented with exact antigen counts, which is what your insurer uses to calculate reimbursement.
Visit Summary & Itemized Receipt
Before you leave, you receive a printed and emailed itemized receipt listing every code, charge, and the expected insurance adjustment. You are never handed a bill you can't read.
After Your Visit
Your EOB, translated.
When your Explanation of Benefits arrives, we've already matched every line item. Our billing team fields questions on your behalf — you don't need to call the insurer yourself.
Codes involved
Claim Submission & Tracking
Claims are submitted electronically within 24 hours of your visit. We track status in real time through our clearinghouse and alert you immediately if a payer requests additional information.
EOB Review & Patient Explanation
Your EOB will show "amount billed," "amount allowed," "plan paid," and "patient responsibility." We send a plain-language translation within 48 hours of receiving your EOB — before your statement arrives.
Appeals & Denial Management
If a claim is denied, we file an appeal within 5 business days — at no cost to you. Denial reasons (CO-4, CO-97, PR-96) are handled internally. Our appeal success rate is 78%.
Your plan, your
exact coverage.
Select your insurer below. Every coverage detail, prior authorization requirement, and billing code — specific to how your plan processes allergy care.
Updated February 2026
Coverage details verified against current plan documents. Individual benefits may vary.
Aetna
PPO, HMO, and Medicare Advantage plans accepted
Covered Services
Allergy Skin Testing (CPT 95004)
80% after deductible
Up to 70 antigens per session
Immunotherapy Preparation (CPT 95165)
80% after deductible
Prior auth required for >12 vials
Immunotherapy Injection (CPT 95115)
$25–40 copay
Frequency: up to 2x/week
New Patient Visit (CPT 99204)
$30–50 specialist copay
No referral needed for PPO
Not Covered
OTC antihistamines
Patch test supplies (patient-supplied)
Missed appointment fees
Prior Auth Required
Immunotherapy >12 vials
Sublingual drops (off-label)
Biologic therapy (Dupixent)
Billing Team Note
Aetna PPO members do not need a PCP referral. Bring your insurance card and photo ID. Deductibles reset January 1.
Blue Cross Blue Shield
BCBS Federal, individual, and group plans
Covered Services
Allergy Skin Testing (CPT 95004)
90% after deductible
Federal plans: no prior auth
Immunotherapy Preparation (CPT 95165)
80% after deductible
Annual reauthorization required
Immunotherapy Injection (CPT 95115)
$20–35 copay
Can be administered same day as visit
Spirometry (CPT 94010)
80% after deductible
Bundled with E&M codes
Not Covered
Experimental sublingual drops
Non-FDA-approved antigens
Cosmetic patch testing
Prior Auth Required
Biologics (Xolair, Dupixent)
Allergy extract >14 vials
Home administration kits
Billing Team Note
BCBS Federal Employee Plan (FEP) covers immunotherapy at 85% with no prior auth. Call member services at the number on your card to confirm your specific plan benefits.
UnitedHealthcare
Choice Plus, Navigate, and Medicare Advantage
Covered Services
Allergy Skin Testing (CPT 95004)
80% after deductible
Limit 70 antigens per date of service
Immunotherapy Preparation (CPT 95165)
80% after deductible
PA required — we submit on your behalf
Immunotherapy Injection (CPT 95115)
$30–45 copay
Navigate plans require PCP referral
Patch Testing (CPT 95044)
80% after deductible
Separate deductible may apply
Not Covered
Sublingual immunotherapy (most plans)
Non-standardized extracts
Air purifiers / HEPA equipment
Prior Auth Required
All immunotherapy preparations
Biologic injections
Spirometry with bronchodilator
Billing Team Note
UnitedHealthcare Navigate plans require a PCP referral before your first visit. We can help you obtain this. Choice Plus members can self-refer to any in-network specialist.
Medicare
Part B, Medicare Advantage, and Medigap
Covered Services
Allergy Skin Testing (CPT 95004)
80% after Part B deductible
$240 Part B deductible (2026)
Immunotherapy Preparation (CPT 95165)
80% Part B
No prior auth required under traditional Medicare
Immunotherapy Injection (CPT 95115)
80% Part B
20% coinsurance applies
Pulmonary Function Test (CPT 94010)
80% Part B
Must be medically necessary
Not Covered
Part D drugs administered in office (billed separately)
Custodial or maintenance care
Most preventive allergy screenings
Prior Auth Required
Biologic therapy (requires Medicare Advantage PA)
Home nebulizer equipment
Durable medical equipment
Billing Team Note
Traditional Medicare Part B covers 80% of approved allergy services after your annual deductible. If you have a Medigap supplement, it typically covers the 20% coinsurance. Medicare Advantage plans vary — we verify benefits before every visit.
Self-Pay & Uninsured Patients
We offer transparent self-pay pricing with no hidden fees. New patient visits start at $185. Allergy testing panels start at $240. Payment plans available. Ask about our sliding scale for qualifying patients.
The moment it
clicked for them.
“My son was prescribed immunotherapy and I spent three weeks trying to figure out if our United plan covered it. One call to Clarity's billing team and I had a written breakdown in my inbox within two hours. The prior auth was already submitted. I cried — the good kind.”
Priya Raghunathan
Parent, 8-year-old with environmental allergies
Portland, OR
“I was handed an EOB with seventeen line items and no explanation. The codes looked like a foreign language. Clarity sent me a plain-English translation before I even called — every code matched to what I remembered happening in the room. That's when I trusted them.”
Marcus Osei
Adult patient, newly diagnosed asthma & rhinitis
Chicago, IL
“I'm at the front desk and I was fielding the same seven insurance questions every single morning. Clarity's resource page cut those calls by more than half. Patients arrive knowing their copay, knowing their prior auth status. It makes the whole day run differently.”
Sandra Kowalczyk
Front Desk Coordinator, Allergy & Asthma Associates
Milwaukee, WI
“Insurance shouldn’t be the hardest part of getting better.”
— The Clarity Billing Team
Everything first.
The download is a bookmark.
We give away every code, timeline, and policy detail on this page. The checklist is simply a formatted version you can bring to your appointment — or share with your coordinator.
Insurance Visit Checklist
PDF · 2 pages · Updated Feb 2026
A plain-language checklist covering everything to bring, everything to ask, and every code to know before your allergy appointment.
What's inside
Verify My Coverage
Our billing team runs a live eligibility check and sends you a written breakdown within 2 business hours.
Secure · HIPAA compliant · Response within 2 business hours
2 hrs
Average verification response
HIPAA
Encrypted & compliant
7 codes
Most common allergy CPTs
Free
No cost to patients