CurrentBlue Cross Blue Shield - MassachusettsPolicy 589

Leukocyte Histamine Release Test (LHRT) Coverage Policy

This policy governs coverage and prior authorization requirements for the leukocyte histamine release test (LHRT) for Blue Cross Blue Shield - Massachusetts members across Commercial and Medicare products.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyLeukocyte Histamine Release Test (LHRT) Coverage Policy

Policy CodePolicy 589

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain precertification/preauthorization when the procedure is performed inpatient; outpatient performance is not covered for listed product types.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalCoverage stance for LHRT

86343CPT code listed for LHRT

Precert required if inpatientAuthorization requirement note

Coverage Criteria for LHRT

Not Covered — Investigational

Covered when ALL of the following are met:

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Investigational stance: The leukocyte histamine release test (LHRT) is investigational as a technique for the diagnosis and management of allergic disorders.

Applies to Commercial and Medicare products as described.

Outpatient coverage exclusion: Outpatient performance of the LHRT is not a covered service for Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO BlueSM, and Medicare PPO BlueSM members.

See Provider Actions for precertification requirements when performed inpatient.

Evidence summary: Testing is considered investigational due to insufficient evidence on diagnostic accuracy; published studies are potentially prone to spectrum, referral, and ascertainment bias and do not permit conclusions on diagnostic accuracy of LHRT.

Although LHRT has been suggested for patients with discordant skin prick and RAST results, supporting studies in this subgroup were not identified.

LHRT is designated investigational because available studies are insufficient to permit conclusions on diagnostic accuracy. Published research is potentially affected by spectrum bias, referral bias, and ascertainment bias, and no adequate studies were identified that address use in targeted subgroups (for example, patients with discordant skin-prick and RAST results).

Provider Actions and Precertification

Prior Authorization

Prior Authorization Required

Precertification / Coverage Requirement — precertification required if inpatient; outpatient performance described

Precertification/preauthorization IS REQUIRED for services described in this policy when the procedure is performed inpatient for all product types.
When performed outpatient, the service is not covered for the following product types: Commercial Managed Care (HMO and POS); Commercial PPO and Indemnity; Medicare HMO Blues; Medicare PPO Blues.

Documentation Required

Provider Action Required

Provider action: ensure appropriate authorization and documentation before scheduling or performing the procedure. If the procedure will be inpatient, obtain precertification prior to admission. For outpatient settings, verify member benefit coverage because the service is not covered for specified product types.

Obtain and document precertification/preauthorization for inpatient procedures.
Check member benefits for outpatient coverage; for listed product types outpatient performance is not covered and should not be billed as covered service.

Billing Rule

Coding and Reporting

Coding and Reporting — report services using current industry-standard codes and modifiers

Report all services using the most up-to-date industry-standard CPT, HCPCS, revenue, and ICD-10 diagnosis codes, and include applicable modifiers.
Inclusion or exclusion of a code in this policy does not by itself determine member coverage.

Note

Coding Examples

Covered / Not covered coding examples

CPT: 86343 — Leukocyte histamine release test (LHR).
Providers must confirm coding and coverage with the member's specific plan and obtain prior authorization when required.

Background

The leukocyte histamine release test (LHRT) is an in vitro assay that measures histamine release from leukocytes/basophils after exposure to specific allergens. It is intended to provide an in vitro correlate to an in vivo allergic response and differs from serum-specific IgE assays (such as RAST) which measure circulating antigen-specific IgE; older LHRT methods required complex leukocyte isolation, though newer solid-phase and automated approaches have been developed.

Definitions

LHRT — definition of leukocyte histamine release test

Test nameLeukocyte histamine release test (LHRT)

PurposeIn vitro assay intended to provide a correlate to an in vivo allergic response by measuring histamine released from basophils after allergen exposure to a patient’s peripheral blood leukocytes.

Method summaryAn allergen is added to the individual’s peripheral blood leukocytes and the in vitro release of histamine from basophils is measured (historically required leukocyte isolation; newer methods use solid-phase glass fibers and automated assays).

Contrast with RASTLHRT measures cellular histamine release from basophils, whereas RAST measures serum levels of antigen-specific IgE as an index of allergic reactivity.

Technological advancesRecent development of histamine-binding glass fibers and simplified automated assays (ELISA and radioimmunoassays) has renewed clinical interest in LHRT for food, inhalant, and drug allergies.