mp-071 - Medical Policies - Alabama
Policy Number: MP-071
Latest Review Date: June 2019
Policy Grade: D
Allergy testing may be considered medically necessary when clinically significant allergic symptoms exist; conservative therapy has failed, or has not been tolerated by the patient. The antigens should generate an IgE mediated response and exist in the patient’s environment with a reasonable probability of exposure.
The following allergy testing modalities are considered eligible for coverage when the above medical criteria are met:
Direct skin testing-includes percutaneous and intracutaneous
Specific IgE in Vitro Tests- (RAST, MAST, FAST, & ELISA)
Total Serum IgE concentration (only for suspected allergic bronchopulmonary aspergillosis, immune deficiency disease characterized by elevated IgE levels, IgE myeloma, or pemphigoid)
Bronchial Challenge Test
Oral Food Challenge/Ingestion Challenge Test
Serial/Skin endpoint titration/testing (SET)
Photo Patch Test
For the above allergy testing modalities excluding Patch/Photo Patch testing, a combination or a total of 65 tests per every three years (based on dates of service) may be considered as medically necessary.
Retesting with same antigen should not be necessary within a three-year period unless a patient transfers to another practice, or when a patient is having a poor response to immunotherapy.
Documentation would include that the patient continues to have symptoms that interfere with activities of daily living despite optimal immunotherapy.
Claims for retesting or additional testing are non-covered unless supporting documentation clearly documents the medical necessity in the individual case.
Testing done on a separate day for different antigens is acceptable as long as the number of tests does not exceed the screening limits.
Patch/Photo Patch allergy testing will be considered separate from the above allergy testing modality limits. A limited series of patch tests may be an appropriate initial step. Standard panels of allergens for patch testing are available from various commercial sources; the most commonly used patch test unit includes 35 common allergens and 1 negative control. In addition to the standard series of 36 patch tests, fourteen (14) additional allergens targeted at the patient's most likely exposures may be performed.
A combination or a total of 50 Patch/Photo Patch test per every three years (based on dates of service) may be considered as medically necessary.
Greater than 50 patch tests within a three year period may be reviewed by individual consideration. Documentation of medical necessity for over 50 tests is required.
More comprehensive patch testing (greater than 50 patch tests) may be considered medically necessary when BOTH A) and B.) are met:
A. The patient has persistent allergic contact dermatitis (ACD) after being previously evaluated and treated (including 6 weeks of avoidance of any allergens that were positive on initial patch testing, and use of topical steroid products if appropriate)
The patient has ANY of the following:
At least 8 weeks of dermatitis without resolution with treatment
Has a dermatitis that may be implanted device-related
Is undergoing pre-testing for medical or dental device placement
Requires extensive patch testing to determine if persistent dermatitis is allergic contact dermatitis
Has seen at least one other physician who has requested specialty patch testing
B. The dermatitis interferes with the patient’s normal activities of daily living, such as occupational or work activities (use of hands), sleep patterns (due to itching), bathing or social interactions.
Food allergy testing is covered only in patients with documented symptoms following ingestion of certain foods, and avoidance of those foods has not proven to alleviate the symptoms. An initial screening of no more than 20 foods is covered with documented medical necessity.
Allergy testing performed by the following methods are considered not medically necessary and investigational:
Conjunctival Challenge Testing /Ophthalmic mucous membrane test
Direct nasal mucous membrane test/ Nasal challenge test
Provocative Neutralization Testing (e.g. Rinkel test)
Cytotoxic Food Testing, Leukocytotoxic test (Bryan’s test)
Mediator Release Test
Sage Allergy Testing
Leukocyte Histamine Release Test (LHRT)
Rebuck Skin Window Test
Passive Transfer of P-X (Prausnitz-Kustner Test) (this test is obsolete and was replaced by radioallergosorbent tests [RAST])
DESCRIPTION OF PROCEDURE OR SERVICE:
The immune system is the body’s defense against harmful substances. An allergy is the immune system’s response to certain items that the immune system considers foreign and harmful— things like specific foods, animal dander, pollens, drugs, mold, and many other substances. The substances that create allergic reactions are known as allergens. In people with allergies, their immune system overreacts to allergens by creating an antibody (a protein specially made to fight a particular substance) known as immunoglobulin E (IgE).
Allergic reactions can cause several different types of symptoms, such as a runny nose, watery eyes, or hives. Serious reactions can range from breathing difficulties to life-threating swelling in the mouth or throat. Diagnosing allergies often involves testing the skin or measuring the ability to breathe, or looking at IgE levels in the blood.
There are a variety of tests to identify the allergens that may be responsible for an individual’s allergic disease. Allergy testing can be broadly subdivided into two methodologies:
1. In vivo methodologies include skin allergy testing (i.e., skin prick testing, skin scratch testing, intradermal testing, skin patch testing, and skin endpoint titration), bronchial provocation tests, and food challenges.
2. In vitro methodologies include various techniques to test the patient’s blood for the presence (serum level) of specific IgE antibodies to a particular antigen (i.e., RAST and ELISA tests).
The optimum management of the allergic patient should include a careful history and physical examination and may include confirming the cause of allergic reaction by information from various testing methods.Once the offending allergen is identified treatment is provided by avoidance, medication and/or immunotherapy. It is essential to the care of allergic patients to determine which allergens may be inciting their disease because this information is used to direct allergy prevention and treatment.
Direct Skin Testing
Percutaneous (scratch, prick, or puncture)
Percutaneous (scratch, prick, or puncture) tests are performed for inhalant allergies and for suspected food hypersensitivity. This is covered only in patients if the adverse food reaction is suspected to be immune related. This will require detailed documentation of the patient’s history and a description of the reaction to the suspected foods, which should include documentation of the symptoms following ingestion of suspected foods and of the modification of symptoms after the avoidance of these foods. Any additional testing would require results of initial screening and patient’s history. (CPT 95004, 95017, 95018)
Intradermal tests are usually performed following negative prick/puncture tests, and are approximately 100- to 1000-fold more sensitive. Intradermal testing is not performed in the diagnosis of food or latex allergy, due to an unacceptably high rate of both false positives and systemic reactions to testing. In contrast, intradermal testing is important in the diagnosis of drug and insect venom allergies. (CPT 95024, 95027, 95028)
Skin Patch Testing (Application Testing)
Patch testing is a form of skin testing used to determine the cause of allergic contact dermatitis. Small disks or chambers containing different chemicals are taped to a patient’s back for several days. Small areas of localized inflammation may appear within 2-4 days, or even up to a week, and confirm the presence of sensitivity to a variety of substances, including metals, rubber compounds, fragrances, preservatives and sometimes medications. This form of testing is looking for delayed skin reactions, also called type IV hypersensitivity reactions, and helps the provider determine if a person’s skin inflammation is due to contact with something in their home or work environment. Patch testing is different from skin prick testing and is not used to diagnose immediate or acute hypersensitivity to foods and other allergens. (CPT 95044)
Photo Patch Testing
Photo patch testing reflects contact photosensitization. A patch of skin is applied with the suspected sensitizer for 48 hours. If no reaction occurs, the area is exposed to a dose of ultraviolet light sufficient to produce inflammatory redness of the skin. If the test is positive, a more severe reaction develops at the patch site than on the surrounding skin. (CPT 95052)
Inhalation Bronchial Testing
Inhalation Bronchial Testing (not including necessary pulmonary function tests), histamine, cold air or methacholine is used to perform this test when it is necessary to determine if the patient has hyper-responsive airways. Volatile chemicals are used to perform the test when the allergy is encountered in an occupational setting. If dust, ragweed or other common allergens are the suspected cause of the problem, this test is not medically appropriate since skin tests can be used in these situations. Infrequently, aerosol challenge is indicated for occupational exposures, e.g., plicatic acid for cedar workers and fish extracts for fishermen. Inhalation bronchial testing (not including necessary pulmonary function tests); with antigens or gases. (CPT 95070/ 95071)
Oral Food Challenge/Ingestion Challenge Test
Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance) also known as the “Double Blind Food Test”. The physician has the patient ingest specific substances, such as food or drugs, to determine which sensitivity is suspected, to show that a hypersensitivity no longer exists, and to determine a sensitivity when a history is vague or allergy testing is equivocal. The patient is observed by qualified medical staff during the challenge. The observation and any reactions are documented. (CPT 95076, 95079)
Truly double-blinded challenges are rarely performed in clinical practices, and are usually done in research studies.
Gammaglobulin, IgE is a testing modality not indicated in most allergic patients, but may be indicated for those patients suspected of having allergic bronchopulmonary aspergillosis, immune deficiency disease characterized by increased IgE levels (e.g., Wiskott-Aldrich syndrome, hyper-IgE staphylococcal abscess syndrome), IgE myeloma or pemphigoid. (CPT 82785)
Allergen specific IgE
Allergen specific IgE (CPT 86003, 86005) tests detect antigen-specific IgE antibodies in the patient’s serum. They are medically appropriate only when testing for allergens (e.g., inhalant, food, insect, drug): when direct skin testing is impossible due to extensive dermatitis or marked dermatographism; for patients unable to discontinue use of antihistamines or other interfering medications (e.g., antidepressants, beta blocking agents); for those who have had a near fatal reaction to an allergen.
In vitro testing is done when the history is suggestive of an allergy, but skin testing is negative or equivalent. It is also done to follow patients with food allergies for prognostic purposes and for confirmation of the loss of allergy, before oral challenge. After a careful history is obtained, the patient’s symptoms must indicate a possibility of a hypersensitivity reaction. Medical necessity is not established for in-vitro testing if there are no allergy symptoms. These tests include Radioallergosorbent Test (RAST), Multiple Radioallergosorbent Tests (MAST), Fluorescent Allergosorbent Test (FAST), and Enzyme-linked Immunosorbent Assay (ELISA).
Skin/Serial Endpoint Titration/Testing (SET, SDET, IDT):
Skin endpoint testing (SET, SDET, IDT) (CPT 95027) is a form of intradermal skin testing that uses increasing doses of antigen to determine the concentration at which the reaction changes from negative to positive (the “endpoint”). It is the weakest dilution that produces a positive skin reaction and initiates progressive increase in the diameter of the wheals with each stronger dilution. SET has also been used to guide the initiation of immunotherapy by using the endpoint dilution as the starting antigen dose.
Conjunctival Challenge Testing /Ophthalmic Mucous Membrane Test
Ophthalmic mucous membrane test (CPT 95060), also known as conjunctival challenge test, is done by placing an allergenic extract into the conjunctival sac of the eye followed by observation for redness, itchiness, tearing of the eye, and other similar symptoms. This testing modality is non-covered and investigational as it has not been proven to be effective.
Direct Nasal Mucous Membrane Test/Nasal Challenge Test
Direct nasal mucous membrane test (CPT 95065), also known as nasal challenge test, provides precise measurements of changes in nasal airway resistance and is seldom used because of the instrumentation required. This test is used in studies of allergic rhinitis, but its utility in clinical practice has not been established. The role of nasal challenge testing in the diagnosis and management of allergic diseases has not been established.
Provocative Neutralization Testing
Provocative testing (e.g., Rinkel test) is a procedure that evolved from serial endpoint titration and has been proposed as a test for allergies to foods, inhalants and environmental chemicals. Patients are exposed to test doses of substances intradermally, subcutaneously or sublingually, with the goal of either producing or preventing symptoms. This is an unproven test.
Cytotoxic Food Testing, Leukocytotoxic Test
Cytotoxicity, Leukocytotoxic test (Bryan’s test, Metabolic Intolerance Test or sensitivity testing) is a test in which leukocytes from the serum of an allergic individual are observed for histamine release in the presence of an antigen. This test is rarely done except in a research setting. There is no proof that this is effective for foods or pollens.
Leukocyte Histamine Release Test (LHRT)
Leukocyte Histamine Release Test (LHRT) is a test which measures the amount of histamine released from the white blood cells in response to exposure to an antigen. The published literature is not sufficient to permit conclusions on the diagnostic accuracy of LHRT.
Rebuck Skin Window Test
Rebuck Skin Window Test is a test of the inflammatory process: Skin is abraded and a cover applied to the abraded area. The cover is replaced at specified intervals and examined for the presence of immune response cells. This testing modality is non-covered and investigational as it has not been proven to be effective. This test is not useful in documenting allergies since other immunodeficiencies can be found in patients with allergic conditions.
Passive Transfer of P-X (Prausnitz-Kustner Test)
Passive Transfer of P-X (Prausnitz-Kustner Test) is performed by injecting a serum intradermally from an allergic patient into a non-allergic patient and later challenging the injection site with antigens or danger of transferring infections. This testing modality is non-covered and investigational as it has not been proven to be effective.
Mediator Release Test
The MRT has primarily been used to detect intolerance to foods and additives in patients with irritable bowel syndrome (IBS). It has also been promoted for use in patients with, but not limited to: chronic fatigue syndrome, migraine headaches, rheumatologic disorders, and dermatologic conditions. The results of the MRT have been used to design a patient-specific diet.
This testing modality is non-covered and investigational as it has not been proven to be effective.
The American Academy of Allergy, Asthma and Immunology (AAAAI) in its allergy report cites that each year more than 50 million Americans suffer from allergic disease. Rhinitis, sinusitis, dermatitis, asthma, food allergy, and other allergic disorders negatively impact quality of life and escalate healthcare costs. Allergies are the 6th leading cause of chronic disease in the United States and are costing the healthcare system over $18 billion annually.
Atopic dermatitis (AD), also known as atopic eczema, is a chronic relapsing inflammatory skin condition. Incidence of AD has increased 2- to 3-fold in industrialized nations, impacting approximately 15% to 20% of children and 1% to 3% of adults worldwide. "Atopic" means that there is typically a genetic tendency toward allergic disease. Atopic dermatitis usually begins in the first few years of life and is often the initial indication that a child may later develop asthma and/or allergic rhinitis (hay fever). In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp. Symptoms of atopic dermatitis (eczema) include:
Allergic rhinitis patient’s immune system mistakenly identifies a typically harmless substance as an intruder, called an allergen. The immune system responds to the allergen by releasing histamine and chemical mediators that typically cause symptoms in the nose, throat, eyes, ears, skin and roof of the mouth. Seasonal allergic rhinitis (hay fever) is most often caused by pollen carried in the air during different times of the year in different parts of the country. Allergic rhinitis can also be triggered by common indoor allergens such as the dried skin flakes, urine and saliva found on pet dander, mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis, as symptoms typically occur year-round. In addition to allergen triggers, symptoms may also occur from irritants such as smoke and strong odors, or to changes in the temperature and humidity of the air. This happens because allergic rhinitis causes inflammation in the nasal lining, which increases sensitivity to inhalants. Many people with allergic rhinitis are prone to allergic conjunctivitis (eye allergy). In addition, allergic rhinitis can make symptoms of asthma worse for people who suffer from both conditions.
Allergic asthma is the most common form of asthma. Many of the symptoms of allergic and non-allergic asthma are the same. However, allergic asthma is triggered by inhaling allergens. An allergen is a typically harmless substance such as dust mites, pet dander, pollen or mold. If you are allergic to a substance, this allergen triggers a response starting in the immune system. Through a complex reaction, these allergens then cause the passages in the airways of the lungs to become inflamed and swollen. This results in coughing, wheezing and other asthma symptoms.
In food allergies, the immune system overreacts to a particular protein found in that food. Symptoms can occur when coming in contact with just a tiny amount of the food. Many food allergies are first diagnosed in young children, though they may also appear in older children and adults. Most adverse food reactions in adults are due to various forms of food intolerance, which are nonimmunologic reactions.
Eight foods are responsible for the majority of allergic reactions:
Clinical features of food intolerances traverse a spectrum of organ systems and vary among different disorders, although most involve prominent gastrointestinal symptoms. Excessive intestinal gas, bloating, abdominal pain, and diarrhea are common symptoms.
The purpose of allergy testing is to identify the allergens that contribute to the allergic disease process. By identifying the allergen, the patient can avoid exposures, and the disease can be managed appropriately. Allergy testing can be performed for a variety of aeroallergens (inhalant allergens), foods, latex, venom and some medications. The Annals of Allergy, Asthma, & Immunology, March 2008 summary statement 43, “The number of skin tests and the allergens selected for skin testing should be determined based on the patient’s age, history, environment and living conditions (e.g., region of the country), occupation, and activities. Routine use of large numbers of skin tests or routine annual tests without a definite clinical indication are clearly not justified.”
Skin testing is a major method for identifying allergen-specific immunoglobulin E (IgE). In-vivo testing techniques are divided into two general categories: percutaneous and intradermal tests. Intradermal tests are used commonly when a significant history is obtained and results of the percutaneous tests are negative or equivocal. In vivo tests, most commonly skin tests, are viewed by many as the most relevant indicator of IgE antibody since they involve direct observation of a biological response in the patient. It remains the primary method used by allergists to detect IgE antibody, because of its sensitivity, specificity, speed, cost effectiveness, and ease of performance. Skin tests may be performed by several methods including prick or puncture, and intradermal techniques.
In-vitro testing is indicated for patients who have severe cutaneous disease, cannot discontinue medications that interfere with skin testing, or have experienced severe anaphylaxis. These tests were developed to measure serum levels of antigen-specific IgE. In vitro methods for the detection of allergen-specific IgE in serum offer different advantages when compared to in vivo tests. They may offer potentially better quantitation, the ability to detect IgE antibody in the presence of dermatographism, a lack of drug interference by antihistamines and related medications, and the potential for long term storage of serum specimens for longitudinal testing. Radioallergosorbent test (RAST) and enzyme-linked immunosorbent assay (ELISA) are commonly used.
PRACTICE GUIDELINES AND POSITION STATEMENTS:
American Academy of Allergy, Asthma & Immunology (AAAAI)
The AAAAI website (2014) lists several tests which it believes “are not useful, effective or may
lead to inappropriate diagnosis and treatment.” These tests include:
Allergy screening tests done in supermarkets or drug stores
Applied kinesiology (allergy testing by testing muscle strength or weakness)
Cytotoxicity testing for food allergy
Immunoglobulin G (IgG) testing for food allergy
Rinkel skin titration method
Provocative neutralization testing
The AAAAI 2008 guideline of allergy diagnostic testing includes the following recommendations on intracutaneous:
- “When compared with specific nasal, skin end point titration (SET) is equivalent to prick/puncture skin tests”.
- “Intracutaneous tests should be performed with small volumes (approximately 0.02 to 0.05 mL) of allergens injected intracutaneously with a disposable 0.5-1.0mL syringe.”
- “As a general rule, the starting dose of an intracutaneous allergen test ranges from 100- to 1,000-fold more dilute than the allergen concentration used for prick/puncture tests.”
Gammaglobulin, IgE, allergen, intradermal, percutaneous, intracutaneous, provocative testing, bronchial challenge testing, direct skin test, patch test, application test, photo patch test, ingestion challenge test, serial endpoint testing, SET, ophthalmic mucous membrane test, direct nasal mucous membrane test, Rinkel test, cytotoxic testing, leukocytotoxic test, Bryan’s test, Metabolic intolerance test, Radioallergosorbent test, RAST, Multiple radioallergosorbent test, MAST, Fluorescent allergosorbent test, FAST, Enzyme-linked immunosorbent assay, ELISA, in-vivo, in-vitro, RUSH immunotherapy, mediator release test, MRT, LEAP, Sage allergy testing, T.R.U.E® Test, Oral Food Challenge, skin endpoint titration, Cytotoxic Food Testing, Provocative Neutralization Testing, Conjunctival Challenge Testing
APPROVED BY GOVERNING BODIES:
Coverage is subject to member’s specific benefits. Group specific policy will supersede this policy when applicable.
ITS: Home Policy provisions apply
FEP contracts: FEP does not consider investigational if FDA approved and will be reviewed for medical necessity. Special benefit consideration may apply. Refer to member’s benefit plan.
82785 Gammaglobulin (immunoglobulin); IgE
83516 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method
86001 Allergen specific IgG quantitative or semiquantitative, each allergen
86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each
86005 Allergen specific IgE; qualitative, multi allergen screen (disk, sponge, card)
86008 Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each (Effective 01/01/2018)
86486 Skin test; unlisted antigen, each
95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
95017 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests
95018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests
95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
95027 Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests
95028 Intracutaneous (intradermal tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
95044 Patch or application test(s) (specify number of tests)
95052 Photo patch test(s) (specify number of tests)
95056 Photo tests
95060 Ophthalmic mucous membrane tests
95065 Direct nasal mucous membrane test
95070 Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with histamine, methacholine, or similar compounds
95071 Inhalation bronchial challenge testing (not including necessary pulmonary function tests); with antigens or gases, specify
95076 Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); initial 120 minutes of testing
95079 Ingestion challenge test (sequential and incremental ingestion of test items, e.g., food, drug or other substance); each additional 60 minutes of testing (List separately in addition to code for primary procedure
95199 Unlisted Allergy/Clinical Immunologic Service or Procedure
- American Academy of Allergy Asthma and Immunology. The allergy report: Diagnostic testing, www.aaaai.org.
American Academy of Allery Asthma and Immunology. Food Allergy. https://www.aaaai.org/conditions-and-treatments/allergies/food-allergies
American Academy of Allergy Asthma and Immunology. Allergy Diagnostic Testing: An Updated Practice Parameter. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/allergydiagnostictesting.pdf
American Academy of Allergy Asthma and Immunology. Position statement 2: Some untested diagnostic and therapeutic procedures in clinical allergy, www.aaaai.org.
American Academy of Allergy Asthma and Immunology. Position statement 6: Allergen standardization, www.aaaai.org.
American Academy of Allergy Asthma and Immunology. AAAAI Work Group Report: Allergy Diagnosis in Clinical Practice. November, 2006. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Allergy-Diagnosis-2006.pdf
Bernstein IL, LI JT, Bernstein DI, et al. Allergy diagnostic testing: An updated practice parameter. Annals of Allergy, Asthma and Immunology, March 2008, Vol. 100, pp. S1-S148. Summary available online at: www.guideline.gov. Last accessed May 2011.
Boyce, J. A., Assa’ad, A., Burks, W. W., Jones, S. M., Sampson, H. A., Wood, R. A., et al. (2010). Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report. Journal of Allergy Clinical Immunology, 126 (6 Suppl), S1-S58.
Boyles JH, Jr. A comparison of techniques for evaluating IgE-mediated allergies. Ear Nose Throat J 2011; 90(4):164-9.
Commins, S. et al. Food intolerance and food allergy in adults: An overview. https://www.uptodate.com/contents/food-intolerance-and-food-allergy-in-adults-an-overview?search=allergy%20testing&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5
Hamilton Robert G and Adkinson Jr. N Franklin. In vitro assays for the diagnosis of IgE-mediated disorders. Journal of Allergy and Clinical Immunology, August 2004, Vol. 114, No. 2.
Krouse JH, Mabry RL. Skin testing for inhalant allergy 2003: current strategies. Otolaryngol Head Neck Surg 2003; 129(4 Suppl):S33-49.
Lasley, Mary V. and Shapiro, Gail G. Testing for allergy, Pediatrics in Review, February 2000, Vol. 21, No. 2, pp. 39-43.
Levy D, Burstein R and Strassman AM. Mast cell involvement in the pathophysiology of migraine headache: A hypothesis. Headache, June 2006; 46 Suppl 1: S13-18.
Li, James T. Allergy testing, American Family Physician, August 15, 2002; 66:621-4, 626.
National Institute of Allergy and Infectious Diseases Fact Sheet. Allergy statistics, January 2002. www.niaid.nih.gov/factsheets/allergystat.htm.
Practice parameters for allergy diagnostic testing: Diagnostic tests of IgE dependent reactions (immediate hypersensitivity), Annals of Allergy, Asthma, & Immunology, December 1995, Vol. 75(6). www.allergyparameters.org/file_depot/0-10000000/30000-40000/30326/folder/73825/1995Testing.pdf.
Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol, May 2001; 107(5): 891-896.
Smart, Brian A. Comprehensive care in the allergy/asthma office: Allergy testing using in vivo and in vitro techniques, Immunology and Allergy Clinics of North America, February 1999, Vol. 19, No. 1, pp. 35-45.
Woods, C. AJMC. Atopic Dermatitis: Focusing on the Patient Care Strategy in the Managed Care Setting. June 20, 2017
Medical Policy Group, October 2002 (1)
Medical Policy Administration Committee, October 2002
Available for comment December 18, 2002-February 3, 2003
Medical Policy Group, May 2005 (1)
Medical Policy Administration Committee, May 2005
Available for comment May 21-July 4, 2005
Medical Policy Group, February 2006 (1)
Medical Policy Administration Committee, February 2006
Available for comment February 10-March 27, 2006
Medical Policy Group, September 2006 (1)
Medical Policy Administration Committee, September 2006
Available for comment September 22-November 5, 2006
Medical Policy Group, May 2007 (1)
Medical Policy Administration Committee, May 2007
Available for comment May 31-July 16, 2007
Medical Policy Group, November 2008 (1)
Medical Policy Group, June 2010 (1): No policy changes
Medical Policy Group, January 2011 (1): Code update
Medical Policy Group, March 2011 (1): Updated Key Words and Coding
Medical Policy Group, June 2011 (1): Updated Key Points and References
Medical Policy Group, June 2012 (1): Update to Key Points and References
Medical Policy Group, November 2012 (1): 2013 Code Updates – Added Codes 95017, 95018, 95076, 95079; deleted codes 95010, 95015, & 95075; verbiage update on codes 95004, 95024, and 95027, all effective January 1, 2013
Medical Policy Panel, June 2013
Medical Policy Group, September 2013 (1): Updated with literature review; policy statement unchanged
Medical Policy Group, April 2015 (6): Updates to Policy statement and Key Points. Patch testing (95044) and Photo Patch Testing (95052) to be considered separately for coverage.
Medical Policy Administration Committee, May 2015
Available for comment May 8 through June 21, 2015
Medical Policy Group, February 2017 (6): Updated coding in Description, removed “if performed in the office, considered to be part of the office visit and no additional benefits are provided” from the policy statement section. No change to policy intent.
Medical Policy Group, December 2017: Annual Coding Update 2018. Added new CPT code 86008 effective 1/1/18 to Current Coding. Updated verbiage for revised CPT code 86003 and 86005.
Medical Policy Group April 2018 (6): Edited description of code 86003 in Description section to include “antihistamines”. No change to policy statement.
Medical Policy Group, June 2019 (6): Updated Description, Policy statement clarification, T.R.U.E. TEST® by Allerderm removed, Key Points, Practice Guidelines, Key Words and References. No change to policy intent.
This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a case-by-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i) research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels of care and treatment.
This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure review) in Blue Cross and Blue Shield’s administration of plan contracts.
The plan does not approve or deny procedures, services, testing, or equipment for our members. Our decisions concern coverage only. The decision of whether or not to have a certain test, treatment or procedure is one made between the physician and his/her patient. The plan administers benefits based on the member’s contract and corporate medical policies. Physicians should always exercise their best medical judgment in providing the care they feel is most appropriate for their patients. Needed care should not be delayed or refused because of a coverage determination.
As a general rule, benefits are payable under health plans only in cases of medical necessity and only if services or supplies are not investigational, provided the customer group contracts have such coverage.
The following Association Technology Evaluation Criteria must be met for a service/supply to be considered for coverage:
1. The technology must have final approval from the appropriate government regulatory bodies;
2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes;
3. The technology must improve the net health outcome;
4. The technology must be as beneficial as any established alternatives;
5. The improvement must be attainable outside the investigational setting.
Medical Necessity means that health care services (e.g., procedures, treatments, supplies, devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury or disease or its symptoms, and that are:
1. In accordance with generally accepted standards of medical practice; and
2. Clinically appropriate in terms of type, frequency, extent, site and duration and considered effective for the patient’s illness, injury or disease; and
3. Not primarily for the convenience of the patient, physician or other health care provider; and
4. Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.