by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 29th, 2018
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.