In Vitro Allergy Testing

Effective Date: February 01, 2019
Revised Date: June 07, 2019

Description

In vitro allergy testing determines whether a patient’s serum contains immunoglobulin E (IgE) antibodies against specific allergens of clinical importance. The radioallergosorbent (RAST) test was developed for in vitro (blood) measurement of specific IgE in a patient’s serum. There are several other tests that employ the same principle using different detection systems.

Criteria

In vitro allergy testing for IgE may be considered medically necessary when ANY of the following are met:

  • Direct skin testing is impossible due to an extensive dermatitis or marked dermatographism; or
  • Direct skin testing is contraindicated because of concomitant drug treatment (e.g., psychotropic drugs frequently have H1 blocking characteristics); or
  • When there is difficulty in testing uncooperative patients (e.g., small children or patients with mental or physical impairments); or
  • If direct skin testing has been inconclusive; or
  • As adjunctive tests for allergic bronchopulmonary aspergillosis or parasitic disease; or
  • Individuals who have a clinical history suggesting an unusually greater risk for anaphylaxis or who have had a previous systemic reaction to skin
    testing; or
  • For evaluation of cross-reactivity between insect venoms.

In vitro allergy testing for IgE exceeding 36 tests per year is considered not medically necessary. In vitro allergy testing for IgE that does not meet the criteria of this policy is considered not medically necessary.

Procedure Codes

86003   86008

ELISA/ACT qualitative antibody testing is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Codes

86353 
86849

IgG ELISA, indirect method, is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

Procedure Code

86001

ALCAT (Antigen Leukocyte Cellular Antibody Test) allergy testing is considered experimental/investigational and therefore non-covered. Scientific evidence does not demonstrate the usefulness of these tests.

Procedure Code

83516

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