Allergy Testing

Medical Policy: 02.01.02 
Original Effective Date: November 2003 
Reviewed: September 2011 
Revised: January 2005 

Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

This Medical Policy 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 will be reviewed regularly and be updated as scientific and medical literature becomes available.

Description: 

Allergic or hypersensitivity disorders can manifest themselves as generalized systemic reactions as well as localized reactions in any organ system of the body.  Numerous agents, e.g., pollen, mold, dust mites, animal dander, insect stings, foods or drugs may precipitate allergic or hypersensitive reactions. For details on treatment of allergies, see Policy 02.01.01, Allergy Immunotherapy.

The management of an allergic patient should include a comprehensive history, physical examination and should include confirming the cause of allergies.  Once the agent is identified, treatment is provided by avoidance, medication or immunotherapy.

Allergy tests detect the presence of IgE antibodies to a particular allergen, or something that causes an allergic reaction.  A positive test suggests allergic sensitization to a specific allergen.  There are several in-vitro tests available to diagnose allergies, however, the National Medical and Research Center believes that standard  intradermal or epicutaneous skin tests in correlation with a thorough medical history and physical examination best serves the paitent.  A positive skin test alone does not diagnose an allergy; it must correlate with symptoms experienced when the patient has an allergen exposure. 

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Prior Approval: 

Not applicable

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Policy: 

Percutaneous or epicutaneous testing when IgE-mediated reactions occur to any of the following allergens;

• Aerollergans (such as pollen, mold, dust mites, grass, ragweed, trees) 
• Foods 
• Hymenoptera (stinging insects) 
• Specific drugs (penicillins and molecular agents) 

Intradermal or intracutaneous testing when IgE-mediated reactions occur to any of the following allergens;

• Aeroallergans 
• Foods 
• Hymenoptera (stinging insects) 
• Specific drugs (penicillins and macromolecular agents) 

Intradermal, or intracutaneous tests with allergenic extracts are based on a wheal and flare reaction within 15-20 minutes 

Number of Skin Tests Required:

The evaluation of inhalant allergies may occasionally require a panel of percutaneous tests. However in most cases, a smaller number of tests are required.

Skin Patch test for diagnosing contact allergic dermatitis

Bronchial Challenge testing with antigens or histimine or methachoine to identify new allergies when skin testing is not possible.

Ingestion (oral) challenge test for the following

• Food or other substances (i.e. metabisulfite)
• Drugs, when all of the following are met;

•   History of allergy to a particular drug
•   Treatment with that drug class is essential
•   There is no effective alternative drug

RAST, FAST, ELISA, (86003) PRIST, RIST, MAST, (86005) MRT, VAST, and ImmunoCAP tests (95199); may be considered medically necessary  when percutaneous testing of IgE-mediated allergies to inhalant allergens, foods, insect stings and other allergens such as drugs, can’t be done due to any of the following reasons:

• Patient has severe dermatographism, ichthyosis or generalized eczema
• Patients who are unable to discontinue antihistamines but who are in need of allergy testing
• Difficulty in testing uncooperative patients (e.g. small children or patients with mental or physical impairments)
• When clinical history suggests an unacceptable risk of respiratory insufficiency or anaphylaxis from skin testing
• Skin testing is inconclusive or if the patient is taking a beta blocker that cannott be discontinued. 

These tests may also be covered as an alternative to percutaneous testing for

• The evaluation of cross-reactivity between insect venoms
• As adjunctive laboratory tests for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic diseases
• Cases when direct skin tests for drugs are inconclusive

• Provocative tests (e.g. Rinkel test) for food or food additive allergies
• Nasal challenge test
• Conjunctival challenge test 
• Leukocyte histamine release test (LHRT) 
• Rebuck Skin Window test 
• Passive transfer or P-X (Prausnitz-Kustner) test (replaced by radioallergosorbent test)
• Cytotoxic food testing
• Serial end point test for diagnosis and treatment of allergic disorders 
• Any testing related to the Nambudripad's Allergy Elimination Technique (NAET)
• Any IgG in-vitro assay used for evaluation
• Sublingual allergy desensitization to aerollergens not recommended by the American Academy of Allergy 

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Procedure Codes and Billing Guidelines: 

• To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9-CM diagnostic codes.

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Selected References: 

• TEC assessment by Blue Cross Blue Shield Association, Serial endpoint testing for the diagnosis and treatment of allergic disorders. TEC Bulletin April 5, 2002;volume 19#1:22-24.
• LMRP Allergy Testing June 1, 2000.  Med A News Issue #2006:42-43.
• U.S. Food and Drug Administration (FDA) Compliance Policy Guidelines  Section 370.100; Cytotoxic Testing for Allergic Diseases(CPG 7124.27).
• American Academy of Allergy: Position Statements-Controversial techniques. Journal of Allergy and Clinical Immunology 67:333-338 1980. Reaffirmed 1984.
• Sicherer, SH. Manifestations of food allergy: Evaluation and management. American Family Physician 59:415-424, 1999
• Barrett S, Index of Questionable Treatments; Nambudripad's Allergy Elimination Technique (NAET); www.quackwatch.org; Accessed on the web 12/20/05. 

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Policy History: 

Date                                        Reason                              Action

September 2011                     Annual review                  Policy renewed               

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Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.