Healthfirst's Allergen Testing policy (PO-RE-059v6) is effective August 1, 2026. Specific IgE in-vitro allergy testing, up to 20 allergen-specific antibodies per year, meets coverage criteria when the allergens are chosen based on history, physical examination and environment, and total serum IgE meets criteria for moderate to severe asthma or signs or symptoms of allergic bronchopulmonary aspergillosis. Testing that does not meet coverage criteria includes specific IgE testing performed on the same day as skin prick testing, routine re-testing of the same allergens without a new clinical presentation, ALCAT, IgG, IgA, IgM and IgD testing for allergy signs or symptoms, basophil activation flow cytometry, bead-based epitope assays such as VeriMAP Peanut Dx, and qualitative multi-allergen screens that do not identify a specific allergen.
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01Already effective August 1, 2026: Billing team should confirm that each allergen testing claim meets the policy criteria before submitting it, for the codes listed in this policy: 82784, 82785, 82787, 83516, 86001, 86003, 86005, 86008, 88184, 88185, 95004, 0165U and 0178U.
02Claims for specific IgE in-vitro testing performed on the same day as skin prick testing do not meet coverage criteria.
03Providers should choose the allergens for specific IgE testing based on the patient's history, physical examination and environment.
04Annual re-testing for the same food allergen meets coverage criteria only for children and adolescents being monitored after an initial positive food allergen result.
If missed: Failure to follow proper coding, billing and/or reimbursement policy guidelines could result in the denial and/or recoupment of the claim payment.
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