Allergy Testing 10/29/2018

October 29th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Allergy|Immunology   Medicare   CPT® Coding  
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Allergy testing may be performed due to exaggerated sensitivity or hypersensitivity.  Using findings based on the patient’s complaint and face-to-face exam. Testing may be required to identify and determine a patient's immunologic sensitivity or reaction to certain allergens using certain CPT codes. 

According to CMS, LCD 33261, allergy testing can be broadly subdivided into two methodologies:

A. In vivo testing  (skin tests)

B. In vitro testing (blood serum analysis)

In vitro allergy testing is not covered for the following, because it is considered not medically reasonable and necessary:

  • Patients with no contraindications to skin testing
  • Patients being treated successfully for allergies
  • Patients with mild symptoms
  • Patients who have had negative skin testing for the allergy in question

In vitro testing is covered when medically reasonable and necessary as a substitute for skin testing; it is not usually necessary in addition to skin testing.

Qualitative multi-allergen screen (CPT code 86005) is a non-specific screening test that does not identify a specific antigen and is not covered.

Review the entire LCD of a list of tests are that are considered experimental and investigational therefore not covered. 

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