ICD-10-CM Diagnosis Codes
ICD-10-PCS Procedure Codes
CPT® Procedure Codes
HCPCS Supply/DME Codes
ICD-9-CM Diagnosis Codes
Place of Service Codes
UB04 Condition Codes
UB04 Revenue Codes
Allergy is a form of exaggerated sensitivity or hypersensitivity to a substance that is either inhaled, ingested, injected, or comes in contact with the skin or eye. The term allergy is used to describe situations where hypersensitivity results from heightened or altered reactivity of the immune system in response to external substances. Allergic or hypersensitivity disorders may be manifested by generalized systemic reactions as well as localized reactions in any part of the body. The reactions may be acute, subacute, or chronic, immediate or delayed, and may be caused by a variety of offending agents; pollen, molds, mites, dust, feathers, animal fur or dander, venoms, foods, drugs, etc.
Allergy testing is performed to determine a patient's immunologic sensitivity or reaction to particular allergens for the purpose of identifying the cause of the allergic state, and is based on findings during a complete medical and immunologic history and appropriate physical exam obtained by face-to-face contact with the patient.
Allergy testing can be broadly subdivided into two methodologies:
A. In vivo testing (skin tests): this testing correlates the performance and evaluation of selective cutaneous and mucous membrane tests with the patient's history, physician examination, and other observations.
Language quoted from CMS National Coverage Determination (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.
Unless otherwise specified, italicized text represent quotation from one or more of the following CMS sources:
CMS Manual System, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Sections 20.2, 80.1 and 80.6
CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, Sections 110.9 and 110.11
CMS Manual System, Pub 100-04, Medicare Claims Processing Manual, Chapter 12, Section 200 and Chapter 16, Section 40.7
Contractor Name(Contractor Number) - Contractor Info
First Coast Service Options, Inc. (09102) - Oversight Region I
First Coast Service Options, Inc. (09202) - Oversight Region I
First Coast Service Options, Inc. (09302) - Oversight Region I
Start Date of Comment Period:05/28/2010
Start Date of Notice Period:08/16/2010
Original Effective Date 09/30/2010
August 2010 Update
Contact dermatitis: a practice parameter. (2006). The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), 100, S1-S38.
Food allergy: a practice parameter. (2006). The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), 96, S1-S68.
Other Contractor(s) LCDs
Practice parameters for allergy diagnostic testing: An updated practice parameter. (2008). The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI), 100(3), S1-S148. Retrieved on August 31, 2009 from http://www.acaai.org/Member/PracticeParam/default.htm.
Wang, J., Godbold, J., & Sampson, H. (2008). Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol, 121, 1219-1224.
Wood, R., Segall, N., Ahlstedt, S., & Williams, P. (2007). Accuracy of IgE antibody laboratory results. Ann Allergy, Asthma & Immunol, 99, 34-41.
U.S. Department of Health and Human Services. (2008) National asthma education and prevention program guidelines implementation panel report 3-Guidelines for the diagnosis and management of asthma, (NIH Publication No. 09-6147), 1-44 (Retrieved on November 10, 2009 from http://www.nhlbi.nih.gov/guidelines/asthma/gip_rpt.htm on November 10.
This Local Coverage Determination (LCD) does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this LCD was developed in cooperation with advisory groups, which includes representatives from numerous societies.
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.999 - Not Applicable
CPT Codes that SUPPORT Medical Necessity 86003 95004 95010 95015 95024 95027 95028 95044 95052 95056 95060 CPT Codes that DO NOT Support Medical Necessity
*86343 Leukocyte histamine release test (LHR)
*95831 Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk
*95832 hand, with or without comparison with normal side
*95833 total evaluation of body, excluding hands
*95834 total evaluation of body, including hands
*Services which are also listed in the FCSO LCD for The List of Medicare Noncovered Services
83516 84600 86001 86005 86140 86160 86161 86162 86332 86485 88342 88346 95065
The following ICD-9-CM codes apply only to CPT code 86003: 995.3 V15.09 693.9 693.8 995.64 693.0 782.1 692.9 995.65 995.66 693.1 995.67 995.68 708.0 995.63 708.3 995.29 995.27 995.22 995.20 995.60 995.0 995.61 989.82 989.5 995.62 708.9 708.8 995.69 372.05 493.01 493.00 477.9 477.8 477.2 477.1 995.1 477.0 372.14 493.02 691.8 493.92 493.90 493.91 The following ICD-9-CM codes apply only to CPT codes *95004, 95010, 95015, 95024, 95027, and 95028: 995.7 V15.03 995.60 V15.02 V15.04 V15.05 995.4 995.68 V15.06 995.3 995.63 995.67 995.61 V14.1 995.66 995.64 V14.2 V14.3 995.65 V14.7 V14.8 995.62 V15.01 V14.0 995.69 995.29 691.8 493.02 493.01 493.00 477.9 477.8 477.2 477.1 477.0 472.0 372.14 372.05 708.0 693.1 708.8 995.27 989.5 989.82 995.0 995.1 995.20 698.9 The following ICD-9-CM codes apply only to CPT codes 95044, 95052 and 95056: 692.83 692.9 691.8 692.81 692.6 692.5 692.4 692.89 692.2 692.1 692.0 692.3 The following ICD-9-CM codes apply only to CPT code 95060: 372.14 372.05