Biotoxin Illness


CIRS (Chronic Inflammatory Response Syndrome) - A Form Of Biotoxin Illness

We are fortunate to have Dr. Berry see our patients with CIRS (Chronic Inflammatory Response Syndrome), a form of Biotoxin Illness caused by exposure to the interior of water damaged buildings. Dr. Berry is an expert in CIRS and uses Dr. Shoemaker’s protocol. She is currently part of the Surviving Mold Physicians group. As a member of the 2018 Consensus Panel of Surviving Mold physicians, Dr. Berry co-authored the CIRS Diagnostic Protocol, published in 5/2018 (see link below). In particular, she penned the section regarding the Biotoxin Illness Pathway pathophysiology.

This comprehensive paper is the culmination of extensive collaboration between SM certified providers Scott McMahon MD, Karen Johnson MD, Ming Dooley, Lysander Jim MD, Yvonne Berry MD and Ritchie Shoemaker MD; James Ryan PhD and Michael Schrantz, IEP. This paper will serve as a definitive statement for new providers, interested professionals and patients alike.” Reference:


New Patient Process - Biotoxin Illness/CIRS Program (New Patient Bundle)

New Patient Bundle

1. Chart review (120 min) with Dr. Berry

Your first appointment with Dr. Berry consists of the following: a comprehensive review of your history with particular attention to exposures to water damage and any prior attempted medical interventions; review of your prior medical records; ordering labs including diagnostic CIRS labs and other potential testing, as well as other labs to rule out other possible diagnoses; discussion of the overall treatment of CIRS. (Please note: Only particular laboratories will be allowed for the lab testing, due to special handling required for some of the send out tests and the particular assays used. Dr. Berry will discuss this with you during the appointment.) Prior to your first appointment, please complete our online Biotoxin Illness/CIRS New Patient Questionnaire, as well as the Review of Symptoms Questionnaire.  Additionally, please submit to the office any relevant past medical records (including ER notes, any labs or testing ordered for your symptoms, and progress notes of physicians who have been a part of your care) two weeks prior to the first appointment for review. If you do not have these records, please sign a medical release with Natural Balance so our office can request these from the specific physician offices and testing locations. This is a mandatory part of the initial appointment with Dr. Berry so please prioritize obtaining these records. Additionally, we require you forward any documents to us digitally to cut down on possible cross contamination from documents in the Natural Balance office.

2. Physical Exam with a Natural Balance Physician 

You will additionally have a physical exam with another Natural Balance Physician. During this exam, the physician will be looking for particular findings often correlated with CIRS. The exam will also help to rule out other possible diagnoses. This is mandatory and each patient will require an annual physical exam by a Natural Balance physician to continue working via telemedicine with Dr. Berry during each calendar year. This appointment will include Visual Contrast Sensitivity (VCS) testing, as well as MARCON testing.

3. Patient Education Video

At Natural Balance, we have a passion for empowering patients with insights and understanding. Dr. Berry’s patients now have access to a recording of an informative group talk that reviews the basics of CIRS. It explains what CIRS is and how it is diagnosed based on the research performed by the Dr. Ritchie Shoemaker and his Surviving Mold Physicians group. It reviews the basics on the CIRS lab testing, the Biotoxin Illness Pathway (i.e. the underpinnings of what happens inside a CIRS patient’s body during the syndrome), and the first few steps in the Shoemaker Protocol. Dr. Berry requires that all patients watch this video prior to their first appointment with Dr. Berry.

4. Additional Chart review by the Doctor

Depending on the complexity of the patient’s past medical history and prior medical records, the doctor may require additional time to read the past medical record and organize a medical chart summary.  A chart review fee may be required, and this will be decided on an individual basis at the discretion of the doctor.

Please note: All the above interactions are part of the “New Patient Bundle”. The bundle however DOES NOT include any additional testing, subsequent visits to review lab results, or follow-up appointments.

What to Expect Next for Biotoxin Illness Patients?

Lab Review Visit

After the your New Patient Bundle appointments, you will be ready to review labs that have been drawn based on your particular case, as well as any environmental testing or other additional  testing ordered by Dr. Berry. This appointment is typically 2 hrs long, and it will be scheduled 6-8 weeks after your physical Exam.

Assessment and remediation of your environment

Step 1 of the treatment is an assessment for possible water damage with mold testing, as well as any remediation of your home, school, and work environment – this can be done while awaiting lab test results. Step 2 of the protocol (with the use of toxin resin binders) can be done while patients are working remove the biotoxin exposure in their environment. However, please be aware that no further steps in the protocol can be done until the patient is in a “safe” environment.


Patients are asked to follow up every 6 to 8 weeks, with the appointments lasting between 60 to 90 min.

Frequent Visits to the Ann Arbor Area

Active treatment of CIRS requires retesting about every 2 months at St. Joe’s Reichert Health Center in Ann Arbor and LabCorp laboratories (two separate locations).  Dr. Berry has meticulously worked in concert with St. Joe’s hospital to establish many of specialty CIRS lab tests. For patients who have a suitable Quest lab near them, there are some labs that can be drawn there, as well. However, Quest has stopped running several of the key CIRS labs so Dr. Berry has switched to using St. Joe’s Reichert Health Center and LabCorp for now. It is unfortunate that it requires 2 separate lab locations to accomplish the proper testing, but at this point it is out of necessity.

Natural Balance and Doctors won’t be involved in Litigation

We do get involved in litigations, depositions, workman’s compensation claims, medical disability claims, or writing for any work restrictions. Therefore, if you are seeking medico legal support, our office will not be able to assist you but can refer you to an out-of-state Surviving Mold physician who does offer such services. We are more than happy to continue to treat you from a medical perspective.

Length of Treatment

There is no known cure to CIRS at this moment. Our treatments are aimed to make your condition stable, and help you to manage it in the future. Typically, the Active Treatment Phase could last anywhere between 1 year to a few years, depending on the severity of your own condition. Once the Active Treatment Phase is over, patients will come back to see us about once a year for retesting.

We hope you have found this information helpful and we look forward to working with you. Please contact our office and ask for Lili Boggess, our clinic manager, if you have any further questions! 734-929-23696, extension 11.

Please also visit the following link to learn about Insurance questions: Insurance & Payments

General Pricing Information


New Patient Bundle Biotoxin Illness: $1113.00 (covers all appointments in the ”New Patient Bundle”  described above)

New Patient & Lab Review for Biotoxin Illness, appointments hourly: $450, prorated to length of time spent with the doctor.

Follow ups for Biotoxin Illness, appointments hourly: $370, prorated to length of time spent with the doctor.

Pricing & Diagnostic Codes

Natural Balance is out of network for all insurance, and we do not bill your insurance. We will provide you with a itemized superbill for every encounter with the appropriate E&M codes to submit to your insurance for reimbursement to you directly. However, please understand that we have literally given up on trying to figure out the whims of insurance and cannot guarantee you will be reimbursed as such. For your reference, we have included the codes and pricing we use for the New Patient Bundle and additional new and existing patient visits, phone consults, et cetera to assist you with checking with your insurance company ahead of time if you wish.


New Patient Visit (Bundle - Biotoxin Illness - with “Group Visit for ” $1113.00):

Code        Description                                                           Amount
99205     New Patient Visit (120 minutes)                       $900.00
99354     Medical Office Visit -extra time                         $195.00
VCS Test                                                                                  $18.00

Medical Office Visit  (example of a 1.5 hours lab review appointment)

Code       Description                                                         Amount
99214     Medical Office Visit (60 minutes)                  $450.00
99213     Medical Office Visit (30 minutes)                   $195.00

Follow-up visits

Code       Description                                                         Amount
99213     Medical Office Visit (30 minutes)                   $195.00

Follow-up phone or video conference visits

Code      Description                                                           Amount
99443    Medical Phone Consult or Video Conference (25-30 minutes)       $195.00


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Natural Balance Wellness Medical Center
1601 Briarwood Circle, Suite 475
Ann Arbor, MI 48108
Phone: 734-929-2696
Fax: 877-348-9426
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