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AetnaAll Plans · Coverage · Medical Policy · Allergy & Immunology, Pulmonology, Dermatology +2 moreMedium impact

Allergy and Hypersensitivity (CPB 0038, reviewed 2026-03-10)

Effective date
Not stated in the notice
Identified
Aug 12, 2026

Summary

Aetna covers specific allergy testing when symptoms are not adequately controlled by empiric conservative therapy and the testing correlates with the member's history, risk of exposure and physical findings. Allergy immunotherapy is covered when administered in a medical facility for IgE-mediated allergies such as allergic asthma, dust mite atopic dermatitis, hymenoptera venom sensitivity, mold-induced allergic rhinitis, perennial rhinitis and seasonal allergic rhinitis or conjunctivitis, when the listed conditions are met. Many other tests and treatments are listed as experimental, investigational or unproven, including the ALCAT test, allergen-specific IgG testing, home administration of allergy immunotherapy and oral immunotherapy for most food allergies.

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What to do

Action · 9 steps
01Billing team: Keep the member's record complete for every allergy service.
02The record must contain the medical history, examination and diagnostic test results that support the treatment, plus a documented plan of treatment and dosage regimen.
03When an evaluation and management service is billed on the same day as allergen immunotherapy by the same physician, a separately identifiable service must be documented.
04Documentation must support the code billed, such as the number of venoms or vials, and must be available to Aetna on request.
05The initial allergy screen is 40 in vitro tests for inhalant allergies and 12 for food and other allergies, and testing beyond that screen is not considered medically necessary if all initial results are negative.
06Intradermal tests are not appropriate for diagnosing food allergies.
07Repeated percutaneous allergy testing to monitor immunotherapy response, routine allergy re-testing, and percutaneous tests combined with IgE RAST tests for the same allergens are considered not medically necessary.
08CPT codes 95004, 95017 and 95018 are not covered after allergen immunotherapy.
09Allergy immunotherapy professional services are covered when administered in a medical facility, and home administration of allergy immunotherapy is considered experimental, investigational or unproven.

Codes mentioned

950049501795018950249502795028950449505295056950709507695079951808600386005860088278583520J0165J0169J7674J2357

Original notice

Allergy and Hypersensitivity (CPB 0038, reviewed 2026-03-10)
aetna.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Aetna policiesAllergy & ImmunologyPulmonologyDermatologyENT (Ear, Nose & Throat)GastroenterologyCode 95004Code 95017Code 95018Code 95024Code 95027Code 95028Code 95044Code 95052Code 95056Code 95070Code 95076Code 95079Code 95180Code 86003Code 86005Code 86008Code 82785Code 83520Code J0165Code J0169Code J7674Code J2357

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