CommercialDocumentationLow impact
07.00.21k, Allergy Immunotherapy
Independence Blue Cross·Allergy & Immunology, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Oct 20, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 07.00.21k on allergy immunotherapy, effective 10/20/2025. The policy clarifies immunotherapy phases by replacing "escalation phase" with "build-up phase" terminology and removes the 1cc aliquot requirement. Coverage criteria, supported CPT codes, and clinical guidelines remain substantively unchanged.
Action Required
By October 20, 2025: Billing and clinical teams should review the updated policy language to familiarize staff with the revised phase terminology (build-up phase vs. escalation phase). No immediate billing system changes are required as affected CPT codes (95115, 95117, 95120, 95125, 95165) and HCPCS codes (G0069, G0089) remain unchanged and medically necessary. Educate providers that the 1cc aliquot requirement has been deleted; no documentation of this requirement is necessary for new allergy immunotherapy claims. Verify that medical record templates reflect the build-up and maintenance phase language to support proper clinical documentation and claim support.