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Am I being overcharged for Allergy Shots?

Hello Everyone, after one year of being on Nucala, I finally am able to begin taking allergy shots. Although this is great news, it has come to my attention that my allergist is charging me, not only for the allergy shots (which is thankfully covered by insurance) but for having a nurse administer my allergy shots (not covered by my insurance.)  This is categorized as 99211 with a modifier of 25. I am surprised by this extra charge and, frankly, a little put off by it, especially after contacting other allergists in the area only to find out that they do not charge for administering shots. Unfortunately, I like my allergist and it's not so simple to switch. I therefore pose 2 questions to you: 1) Do you think this is unethical on the part of my allergist? 2) Does your allergist also charge you to have a nurse administer your allergy injections? Thanks,-Joe

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  • Kathy P

    Hi Joe and welcome to AAFA.

    I get allergy shots and I get 2 different charges. One charge is for my yearly serum mix. This only happens once per year. Then I get charged for each injection visit (I get multiple per visit).

    It looks like the 99211 code is for an office visit. I know my allergist schedules a full office visit for the first shots, but then codes for the "resource room" for shots for subsequent injections. Can you ask what will be billed for subsequent visits? I've never had a clinic not charge for administering shots.

    Ah, in fact I found a recent visit of mine where I was in for an office visit AND got my injection at the same time. I was changed for a regular office visit (99213 – established outpatient) and a separate charge for the immunotherapy injection.

    I found this PDF reference that has the Medicare codes for allergy testing and immunotherapy - 

  • Kathy P

    Have you called the billing department or the office itself to ask for an explanation of the billing?