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Allergy Services with Evaluation and Management Services

Provider Type

  • Physicians

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Evaluation and management (E&M) services for established member office visits (99211-99215) are considered to be included with allergy testing (95004-95075) and allergy immunotherapy (95115-95199) unless a significant, separately identifiable service was performed. In this case, bill the E&M code with modifier -25. Documentation is not required with the claim but the medical record must support the use of modifier -25.

Health Net does not require documentation at the time of claim submission; however, in the event the claim is audited, documentation may be required.

Supporting Sources

  • American Medical Association (AMA) CPT Book
  • CMS National Policy
Last Updated: 08/05/2021