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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