If your practice has been experiencing excessive medical record requests for allergy immunotherapy injections (CPT 95115 and 95117), you are not alone—and you now have powerful new peer-reviewed support on your side.
An article in the June 2026 issue of Annals of Allergy, Asthma & Immunology directly addresses this growing burden. Titled “Is Excessive Request for Medical Records the Next Step in the Evolution of Utilization Management?,” the paper is authored by College leaders J. Wesley Sublett, MD, MPH, FACAAI, Maureen M. Petersen, MD, FACAAI, Kathleen H. Grisanti, MD, Melinda M. Rathkopf, MD, MBA, FACAAI, and J. Allen Meadows, MD, FACAAI.
This article is a direct follow-up to the 2024 guidance paper by Dr. Meadows and colleagues on proper payer evaluation of claims for CPT codes 95165, 95115, and 95117. It shows how insurers and PBMs have systematically moved from prior authorization → step therapy → non-medical switching → copay accumulators → alternative funding programs — and are now using excessive, piecemeal medical record requests as the newest weapon to delay or deny legitimate claims.
Key points from the article:
- Practices are being asked for up to eight separate documents one at a time, often demanding original “wet-ink” physician signatures on every injection.
- Claims are paid, then later recouped after exhaustive (and expensive) appeals.
- Artificial intelligence tools are now scanning records to generate requests the payer knows are hardest for physicians to fulfill quickly.
- For low-reimbursement services like allergy shots, the administrative cost often exceeds the payment, leading practices to simply write off the loss — exactly what the payers want.
The authors make a clear call for state and federal legislation to stop these abusive tactics, including strict limits on the number and timing of record requests, upfront disclosure of all required documents, 48-hour decision deadlines, bans on AI-driven “gotcha” requests, and meaningful penalties for bad-faith delays.
Because this is a peer-reviewed publication in a major journal, it carries significant weight when you appeal denials, write to state insurance commissioners, or meet with legislators. It is no longer “just our opinion” — it is now documented in the scientific literature.
The article validates what you are experiencing daily and gives you a roadmap for pushing back — both in individual appeals and in collective advocacy.
The fight for fair reimbursement and patient access continues. This new publication is another important tool in our toolbox.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
