Peanut Immunotherapy (CPB 0968, reviewed 2026-05-27)

By 2026-05-27, billing team must: (1) Update billing system to recognize Palforzia (peanut allergen powder-dnfp) claims and associate them with ICD-10 code Z91.010 (Allergy to peanuts) for commercial Aetna plans only; (2) Implement prior authorization workflow requiring documentation of: confirmed peanut allergy diagnosis (via serum IgE or skin prick test), patient age (1-17 years), concurrent peanut-avoidant diet, and absence of uncontrolled asthma or eosinophilic gastrointestinal disease; (3) Ensure claims include CPT codes 90473 or 90474 (oral immunization administration) when applicable, and H0033 (oral medication administration with direct observation) for supervised initial dose escalation and first doses of up-dosing levels; (4) Add requirement to encounter forms that only allergists or immunologists can prescribe; (5) Flag any claims requesting co-administration with omalizumab (J2357) or emergency treatment indications for denial as experimental/investigational. Failure to obtain proper authorization will result in claim denials for non-compliant submissions.