Same Specialty, Different Value: How Texas Markets Reveal the Undervaluation of Immunology Care

Executive Summary

Allergy and Immunology specialists deliver life-changing care for patients with allergies, asthma, and immunology conditions. Yet, in Texas, payers value this specialty very differently depending on the city and provider type.

Using new Price Transparency data that shows every in-network commercial rate in the country, an analysis of Dallas, San Antonio, and Houston across three high-volume immunology services reveals striking inconsistencies in reimbursement rates between payers, markets, and even between specialists and generalists billing the same service.

At a glance, the graphs, later illustrated, tell the story: specialists are often reimbursed less than generalists for procedures that require years of additional training and expertise. The narrative that follows explains why these disparities matter, how they arise, and what they imply for patients and the healthcare system.

Introduction

Texas offers a unique lens into the valuation of specialty care: 

• San Antonio: Strong military and Tricare presence, with unique payer dynamics.
• Dallas: Large, competitive urban market with many provider options.
• Houston: A diverse, scaled healthcare hub with major academic centers.

For Immunologists, these differences are not abstract. They directly impact financial stability, patient access, and the ability to recruit and retain clinicians.

“These discrepancies are not just numbers. They translate into whether practices can recruit specialists, maintain access for patients, and continue advancing treatment options” explains Melissa Pike, Consultant, Tribunus Health. 

Methodology

Scope of Analysis

• Markets: Dallas, San Antonio, Houston (largest county in each city)
• Latest available data as of September 1, 2025
• CPT Codes: 95004 (allergy testing), 95165 (immunotherapy dosing), 96365(biologics infusion), 99214 (established patient visit)
• Payers: Aetna, UnitedHealthcare, Blue Cross Blue Shield of Texas

Comparisons

• Median negotiated reimbursement by CPT code, by payer, by market. 
• Allergy/Immunology specialists vs. generalists for the same codes.
• Outliers called out to highlight extreme inequities.

The data indicates that for the same services, generalists (indicated by lighter colors) are frequently paid the same as or more than the specialists (darker colors) despite their training to specifically address allergy and immunology healthcare issues. 

General Findings and Implications

Specialists Paid Less Than Generalists

One of the most noteworthy findings is that in certain markets, primary care physicians are reimbursed more than immunologists for the same procedures, even when specialist oversight is crucial to therapy choices that can result in better patient outcomes. 

As Lyn Lewars, Chief Executive Officer of CIIC, explains: 

Immunology practices have long faced systemic undervaluation. Transparent data like this finally gives practices leverage to push back and ensure fair reimbursement for highly specialized care.

The inequity exists not because immunologists provide less value, but because payers have historically lacked the pressure to differentiate. Without access to transparent data, specialists cannot easily demonstrate that they both improve outcomes and save payers money in the long run. Historically, this gap in visibility has undermined their negotiating position, until now.

Market Variability Across Texas

Reimbursement disparities are not uniform. For example, In San Antonio, where Tricare dominates, commercial payer rates for allergen immunotherapy are far lower than in Dallas, where competition between commercial payers drives higher reimbursement. Houston sits somewhere in between.

For biologics infusions, code 96365, UHC consistently pays generalists significantly more than allergy specialists in some markets examined, while for other payers, there is relative parity in rates for this treatment.

As Namar Al-Ganas, VP, Business Development of Tribunus Health noted, “PriceTransparency data makes clear what practices have generally suspected: payers inconsistently value their work. When immunologists are paid less than generalists for the same procedure, it’s time to reset the conversation.”

What We’ve Learned

From both this analysis and prior work with CIIC member practices as well as experience serving multi-year, multi-state allergy practices, several consistent themes emerge:

• Allergy and Immunology practices are disproportionately affected by payers consolidation and undervaluation.
• The specialty is often grouped with ENT or PCP services in payer adequacy reports, diluting its distinct clinical and financial value.
• Successful practices use data to clearly differentiate themselves in terms of patient outcomes and cost savings. 

This is why the specialty requires both advocacy and analytics. As Melissa Pike observed, “Without parity in reimbursement, practices lose ground. With it, they gain stability to invest in the future of care.”

Why It Matters

The Texas data point to a national problem: payer variability is systemic, not market-specific. If immunologists are undervalued in Texas, the same is almost certainly happening in other regions. The broader implications include:

• Access Risks: If specialists are reimbursed below cost and often below CMS Medicare rates, too, they may close locations or reduce services, leaving patients with less specialist care options.
• Workforce Challenges: Lower reimbursement undermines the ability to attract new specialists, exacerbating shortages in a field stretched thin.
• Negotiation Leverage: Practices equipped with transparent data can show payers that undervaluation leads to higher costs over time through misdiagnosis, delayed diagnosis and thus treatment, or unnecessary escalation of care.

The narrative is clear: valuing specialists fairly is not just equitable, it is cost-effective. 

Conclusion

Specialty care should be valued for its expertise, outcomes, and critical role in the healthcare system. The disparities uncovered in Texas show that allergy and immunology remains overlooked in many payer structures. By shining a light on these inequities, this analysis demonstrates why transparent data and clear practice differentiation are essential tools for specialists. 

The story is not about one state or one payer, it is about a national need to realign value with expertise. Fair reimbursement for immunology specialists is about both sustaining existing practices as well as about ensuring patients continue to have access to the highly skilled care they deserve.

Appendix

Data Request: Texas Immunology Price Transparency Analysis

To support the joint Tribunus Health + CIIC white paper, the Tribunus Health data team pulled specific reimbursement data from the Price Transparency tool.

Scope of Analysis

Markets (3):

• Dallas
• San Antonio
• Houston

CPT Codes (4):

• 95004 – Percutaneous allergy testing
• 95165 – Allergen immunotherapy, single dose
• 96365 – Infusion therapy, initial hour (common biologics/Xolair, Dupixent)
• 99214 – Established patient visit

Payers (3):

• Aetna
• UnitedHealthcare
• Blue Cross Blue Shield of Texas

Data Outputs Requested

For each CPT code x market x payer combination:

1. Median negotiated reimbursement rate
2. Minimum and maximum rates observed
3. Range/absolute difference (max – min)
4. Specialist vs Generalist comparison
   • Compare rates when billed by Immunology specialists vs. Primary Care/Generalist providers.