When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
THE FOLLOWING TYPE OF PERCUTANEOUS ALLERGY TESTING IS SUBJECT TO A CUMULATIVE MAXIMUM LIMITATION OF 70 PERCUTANEOUS TESTS PER CALENDAR YEAR:
THE FOLLOWING TYPES OF INTRACUTANEOUS ALLERGY TESTING ARE SUBJECT TO A CUMULATIVE MAXIMUM LIMITATION OF 40 INTRACUTANEOUS TESTS PER CALENDAR YEAR:
THE FOLLOWING TYPES OF SERIAL ENDPOINT TITRATION (SET) TESTING ARE SUBJECT TO A CUMULATIVE MAXIMUM LIMITATION OF 80 TESTS PER CALENDAR YEAR:
95017, 95018, 95027
THE FOLLOWING TYPES OF TESTING ARE NOT SUBJECT TO ALLERGY TEST LIMITATIONS:
95044, 95052, 95056, 95060, 95065, 95070, 95071, 95076, 95079
THE FOLLOWING CODE IS USED TO REPRESENT SUBLINGUAL TESTING (ANTIGENS PREPARED FOR SUBLINGUAL ADMINISTRATION), PROVOCATIVE TESTING (EG, THE RINKEL TEST), OR THE REBUCK SKIN WINDOW TEST:
Policy: 06.02.26d:In Vitro Allergy Testing
Policy: 07.00.21i:Allergy Immunotherapy