Assess whether blood testing fills a clinical need, whether the practice can staff and license a lab, and whether its expected service value justifies the investment. Also review payer rules and billing workflows before building the service model.
Define the clinical role
Allergy & Asthma Network says blood IgE tests are often used when skin conditions or medications prevent skin testing. Some tests measure IgE to specific allergens, and some measure IgE to components of common allergens.
A UTMB allergist explains that patients must stop allergy medication before skin prick testing, and blood testing is used when a patient cannot stop it. A positive skin or blood test shows sensitization, but does not mean exposure will cause symptoms. Patients weighing health decisions should talk with their own doctor.
Set a service and investment case
A Vancouver Business Journal account describes one clinic's reason for bringing blood testing in-house. It reported that send-out samples could take weeks to return and outside labs limited test options. The clinic said its in-house lab offered results within 24 hours and customized tests. Those reported benefits give owners concrete questions to assess, including whether their current turnaround or test menu leaves a service gap.
The same account reports that the allergist-owner invested $100,000 in equipment, dedicated 500 square feet to the lab, and hired a technician. Before committing funds, owners can write down the equipment, space, and staffing needs for their proposed service, then compare those requirements with the value they expect it to deliver.
Resolve licensing and staffing early
The Vancouver Business Journal account says licensing was the biggest hurdle for the clinic owner and a reason many specialists lacked an in-house lab. Treat licensing as an early feasibility item, alongside identifying who will run the lab and how the practice will provide coverage.
A concrete first step is to create a launch checklist with four lines: licensing requirements, technician coverage, dedicated space, and equipment. Assign an owner to confirm each item and record which decisions depend on it. This gives the practice a reviewable basis for deciding whether to proceed.
Check payer fit and billing workflow
Commonwealth Care Alliance says it reimburses medically necessary allergy testing according to member benefits and advises verifying eligibility and benefit details before services begin. That policy applies to CCA members, so owners should check the plans relevant to their own practice before relying on testing revenue.
A CMS billing guideline says allergy testing is generally performed before immunotherapy to identify allergens, and the two services' codes are generally not reported on the same date. The stated exception is when the physician provides immunotherapy and tests for additional allergens that day. Map the proposed workflow against applicable payer policies and confirm coding questions with a qualified billing professional.
This page is general education only. It is not medical advice. Talk with your own doctor about your health.
Frequently asked questions
How are serum IgE and skin testing billed differently in Medicare fee-for-service?
A study of Medicare fee-for-service beneficiaries describes skin testing as a reimbursable physician procedure usually performed by allergy specialists. It describes serum specific IgE tests as performed and billed by reference laboratories without additional physician office visits.
What did the Medicare cost study suggest about skin testing costs?
The authors suggested skin testing may cost Medicare more because it is billed as a procedure, usually performed by allergy specialists, and often involves additional specialist visits for interpretation. This finding comes from the study of Medicare fee-for-service beneficiaries.
What range did Canadian allergists report for specific IgE blood test billing fees?
A survey of allergists in Canada found that specific IgE testing had the narrowest reported fee range among the surveyed services. Its mean reported billing fee was $13.40, with a range of $0 to $40.
Sources
- Allergy Diagnosis and Testing (Allergy & Asthma Network)
- Houston is an 'allergy capital,' UTMB allergist offers survival tips (UTMB Health (University of Texas Medical Branch))
- Lab adds patient value to clinic (Vancouver Business Journal)
- CCA Payment Policy: Allergy Testing and Immunotherapy (Commonwealth Care Alliance)
- Allergy Testing billing and coding guidelines (L36402 attachment) (Centers for Medicare & Medicaid Services)
- Cost of Serum Versus Skin Allergy Testing Among Medicare Fee-for-Service Beneficiaries in the United States (Journal of Health Economics and Outcomes Research)
- Billing fees for various common allergy tests vary widely across Canada (Allergy, Asthma, and Clinical Immunology)
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