Medicare AdvantageDocumentationLow impact
MA07.055e, 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 MA07.055e has been reissued to clarify allergy immunotherapy coverage phases. The policy now uses terminology of 'build-up phase' and 'maintenance phase' instead of 'escalation phase,' and dose/unit limits have been moved from the medically necessary section to the professional services guidelines. The 1cc aliquot requirement has been deleted. These are primarily nomenclature and organizational changes with no substantive coverage alterations.
Action Required
By October 20, 2025: Billing team should review internal allergy immunotherapy documentation and billing guidance to update terminology from 'escalation phase' to 'build-up phase.' No billing code changes are required. Verify that dose/unit tracking for CPT 95165 continues to comply with guideline limits (up to 120 doses/units in first year for build-up phase; up to 90 doses/units per 12-month period for maintenance phases). Update any internal reference materials, templates, or prior authorization language to reflect the new phase terminology. No system changes or claim processing modifications are necessary. Failure to update documentation will not result in claim denials, as coverage criteria remain substantively unchanged.