Medicare AdvantageCoverageMedium impact
MA06.004d, In Vivo Allergy Sensitivity Testing
Independence Blue Cross·Allergy & Immunology, Dermatology, Pediatrics +1 more·Medical Policy
Effective date
Aug 25, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage reissued MA06.004d effective 08/25/2025 with revised coverage criteria for percutaneous and intracutaneous allergy testing, and moved provocation/neutralization testing from experimental to not covered. Billing teams must update claims processing to deny provocation/neutralization testing and ensure allergy testing claims meet the specified medical necessity criteria for IgE-mediated hypersensitivity evaluation.
Action Required
Before 08/25/2025: Billing team must update claims processing system to deny all claims for provocation/neutralization testing (moved from experimental to not covered section). Review CPT codes 95004, 95017, and 95018 to ensure documentation requirements are being met for coverage. Providers must document that testing evaluates IgE-mediated hypersensitivity to covered allergen categories (inhalants, foods, Hymenoptera, chemicals, or specific drugs). Add validation rules to flag and deny provocation/neutralization testing claims. Update denial templates to reference 'not covered per MA06.004d effective 08/25/2025.' Failure to implement will result in improper reimbursement for non-covered services.