The American College of Allergy, Asthma and Immunology and its Advocacy Council have submitted comments to the Centers for Medicare and Medicaid Services on the proposed 2027 Medicare Physician Fee Schedule and Quality Payment Program rule. Our comments focus on the policies most likely to affect allergists, their practices and their patients: physician payment, practice expense data, allergen immunotherapy, remote monitoring, same-day services and the future of Medicare quality reporting. Throughout the letter, our message is consistent: Medicare policy must reflect how allergy care is actually delivered and must not create new barriers for the small and independent practices that make up much of our specialty.
CMS proposes 2027 conversion factors of $33.1693 for qualifying alternative payment model participants and $32.8409 for other clinicians, both lower than in 2026. Although these figures are driven largely by statute and the expiration of the one-time 2.5% increase for 2026, another reduction would widen the growing gap between practice costs and Medicare payment. The College urged CMS to work with Congress toward long-term, sustainable payment reform that gives practices the stability needed to retain staff, maintain technology and invest in patient care.
Our most important specialty-specific comments address CPT code 95165. CMS is reconsidering both Medicare’s definition of a dose and the current medically unlikely edit of 30 units per claim. Medicare presently defines a dose as a 1 cc aliquot, even though an allergy immunotherapy dose varies throughout treatment and is almost never more than 0.5 cc. That disconnect creates inconsistent billing rules, needless administrative work and potential patient-safety concerns. We asked CMS to adopt the CPT definition: a single injection from a multidose vial.
We also proposed replacing the 30-unit per-claim edit with reasonable annual limits that reflect the course of treatment: up to 150 doses in the first year, including the build-up phase, and up to 120 doses annually during maintenance. Allergy extracts are custom prepared for an individual patient, and multiple treatment sets may be clinically necessary because certain allergens cannot safely be combined. Annual limits would give Medicare a meaningful program-integrity safeguard without forcing practices to divide claims artificially or disrupt access to immunotherapy.
Thank you to everyone who supported the CPT 95165 initiative. Based on our monitoring, a significant number of College members took the time to send a letter urging CMS to adopt a clinically accurate definition of a dose and reasonable annual limits. Your participation reinforced the College’s formal comments and demonstrated that Medicare’s current policy affects allergy practices and their patients across the country. We greatly appreciate your willingness to add your voice to this important advocacy effort.
We also asked CMS to defer its proposed changes to the practice expense methodology until the agency provides enough information for specialties to evaluate their effects. We again opposed using the American Medical Association’s 2023-2024 Physician Practice Information Survey data for allergy. Instead of reporting allergy-specific results, the survey combined allergy with several unrelated specialties in an “Office Based Proceduralists” category. That approach assigned the group a practice expense of approximately $174 per hour of direct patient care, 28% below the $241 reported for allergy in 2007-2008. That result is not credible in an era of rising antigen, staffing, rent, technology and USP Chapter 797 compliance costs. We applauded CMS for not adopting those survey data and urged the agency to continue to reject them.
The College also opposed a proposal that would effectively prevent practices from using third-party companies to help furnish remote physiologic monitoring, RPM, and remote therapeutic monitoring, RTM, services. Many small practices lack the staffing and infrastructure to operate these programs entirely in-house. Existing supervision and incident-to requirements already make the billing practitioner responsible for the services. A categorical ban on contracted support could cause practices to abandon remote monitoring even when it helps identify poor medication adherence or worsening disease before a costly exacerbation occurs.
Finally, we urged CMS not to retire traditional MIPS after the 2028 performance period. There is still no clinically appropriate MIPS Value Pathway for allergy. The existing pulmonology, ear-nose-and-throat and primary care pathways contain too few relevant measures and do not reflect the breadth of allergy practice. CMS previously declined the College’s proposed allergy MVP despite finding several of its measures relevant. We asked CMS to approve an allergy-specific pathway, add meaningful allergy measures to existing MVPs, allow cross-MVP reporting, or at minimum protect clinicians from penalties when CMS has not supplied an applicable pathway. We also opposed making a core measure mandatory before every specialty has a viable MVP and asked CMS to retain the distinct adult bacterial sinusitis antibiotic-selection measure.
The proposed rule contains several changes we support, including keeping the MIPS performance threshold and data-completeness requirement at 75%, improving the data used to identify clinicians affected by extreme and uncontrollable circumstances, eliminating duplicative health-information-technology attestations, and the Security Risk Analysis measure. We support electronic prior authorization in principle but recommended that new measures remain voluntary until practices, electronic health records and payers can reliably support the required technology.
The College’s submission gives CMS a practical roadmap: modernize policies that no longer match clinical care, reject inaccurate cost assumptions, reduce unnecessary administrative burden, and ensure that quality programs offer allergists a fair and meaningful way to participate. The CPT 95165 initiative is the immediate opportunity for every member to help carry that message forward.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
