This version of the policy will become effective 03/25/2019. Policy has been updated to communicate the continued coverage of ELISA, ImmunoCAP, and MAST, and the removal of RAST and FAST for in vitro allergy testing, due to review of most current clinical guidelines. Policy has been updated to establish lymphocyte stimulation tests (to include lymphocyte mitogen response assays, lymphocyte transformation tests, and others as detailed in the policy) as a category of testing considered experimental/investigational for in vitro allergy testing, based upon most current clinical guidelines. CPT code 86353 was added to the policy to represent lymphocyte stimulation tests, which are considered experimental/investigational.
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 CODES ARE USED TO REPRESENT MULTIPLE ANTIGEN SIMULTANEOUS TEST (MAST), AND ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA) FOR ALLERGEN-SPECIFIC IgE
NOT MEDICALLY NECESSARY
86001, 86343, 86353
THE FOLLOWING CODE IS USED TO REPRESENT CYTOTOXIC FOOD TESTING
Policy: 07.00.05g:In Vivo Allergy Sensitivity Testing
Policy: 07.00.21i:Allergy Immunotherapy