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Excellus BlueCross BlueShieldCommercial · Coverage · Ear, Nose & Throat (Otorhinolaryngology) · Allergy & ImmunologyMedium impact

Allergy Testing 2.01.10

Effective date
Jul 16, 2026
Identified
Jun 20, 2026

Summary

Percutaneous, combined percutaneous and intracutaneous, intracutaneous, patch, photo patch, photo, inhalation bronchial challenge, ingestion challenge, and gammaglobulin IgE tests are medically appropriate in the diagnosis of the allergic patient, with allergen-specific IgE medically appropriate only under specified circumstances. Allergen-specific IgG when the criteria are not met, the leukocyte histamine release test, ophthalmic and direct nasal mucous membrane tests, peanut allergen-specific ELISA testing, and cytotoxicity, provocative, and Rebuck skin window tests are investigational, and allergy testing for treatment programs such as tolerance induction programs is investigational. The July 16, 2026 update was an annual review with the policy intent unchanged.

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What to do

Action · 4 steps
01Already effective July 16, 2026: Allergen-specific IgE testing (CPT 86003, 86005, 86008) is medically appropriate only when direct skin testing is impossible due to extensive dermatitis or marked dermatographism, for patients unable to discontinue interfering medications (such as antidepressants, antihistamines, or beta-blocking agents), for patients who have had a near fatal reaction to an allergen, in children younger than four years of age, for patients who will not or cannot cooperate with percutaneous testing due to mental or physical disease, to follow patients with food allergies or insect sting allergies previously documented by history and in-vivo or in-vitro testing, for suspected latex allergy, for suspected insect sting allergy with prior negative skin testing, or for suspected penicillin allergy.
02Allergen-specific IgG (CPT 86001), the leukocyte histamine release test (CPT 86343), ophthalmic and direct nasal mucous membrane tests (CPT 95060, 95065), and peanut allergen-specific ELISA tests (CPT 0165U, 0178U) are investigational when the criteria above are not met.
03Inhalation bronchial challenge testing (CPT 95070) is not medically appropriate when dust, ragweed, or other common allergens are the suspected cause, because skin tests can be used in these situations.
04Allergy and laboratory testing for a treatment program, such as a tolerance induction program, is investigational.

Codes mentioned

9500495017950189502495027950289504495052950569506095065950709507695079827858600186003860058600886343B44.0B44.9B48.4D80.3D82.0H10.411H10.419H10.45J30.0J30.1J30.9J45.20J45.998L23.0L23.9L24.0L24.9L25.0L25.9L27.0L27.9L30.0L30.2L30.8L30.9L50.0L50.3T36.0X5AT36.0X5ST36.1X5AT36.1X5ST39.015AT39.015ST39.095AT39.095ST63.001AT63.94XST65.811AT65.814ST78.00XAT78.09XST78.2XXAT78.3XXAT78.40XAT78.41XAT78.49XAT88.2XXAT88.52XAT88.59XAT88.6XXAZ91.010Z91.09

Original notice

Allergy Testing 2.01.10
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesAllergy & ImmunologyCode 95004Code 95017Code 95018Code 95024Code 95027Code 95028Code 95044Code 95052Code 95056Code 95060Code 95065Code 95070Code 95076Code 95079Code 82785Code 86001Code 86003Code 86005Code 86008Code 86343Code B44.0Code B44.9Code B48.4Code D80.3Code D82.0Code H10.411Code H10.419Code H10.45Code J30.0Code J30.1Code J30.9Code J45.20Code J45.998Code L23.0Code L23.9Code L24.0Code L24.9Code L25.0Code L25.9Code L27.0Code L27.9Code L30.0Code L30.2Code L30.8Code L30.9Code L50.0Code L50.3Code T36.0X5ACode T36.0X5SCode T36.1X5ACode T36.1X5SCode T39.015ACode T39.015SCode T39.095ACode T39.095SCode T63.001ACode T63.94XSCode T65.811ACode T65.814SCode T78.00XACode T78.09XSCode T78.2XXACode T78.3XXACode T78.40XACode T78.41XACode T78.49XACode T88.2XXACode T88.52XACode T88.59XACode T88.6XXACode Z91.010Code Z91.09

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