CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO13

Allergen Testing

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Defines Blue Cross Blue Shield of New Mexico reimbursement and coverage criteria for laboratory allergen testing (specific IgE, total IgE, multi-allergen screens, basophil activation tests, ALCAT, and related assays) for plan members and providers.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyAllergen Testing

Policy CodePolicy CPCPLABO13

Change TypeMaterial and non-material edits (clarifications and consolidation)

Effective DateSep 5, 2025

Last ReviewApr 28, 2025

Next Review Date

Key ActionVerify product-specific coverage and any required authorization per plan documents before ordering allergen testing.

SourceLink

POLICY UPDATE CHANGES

Removed reimbursement guidance item #1 which was for guidance only.

Edited reimbursement statement #3 for clarity regarding annual re-testing for food allergens in children and adolescents.

Combined prior items #7 and #8 into a single statement clarifying basophil activation flow cytometry and in‑vitro testing of IgG/IgA/IgM/IgD are not reimbursable for individuals with signs or symptoms of allergies.

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CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO13

Allergen Testing

Customize your policy alerts

Sign up for Blue Cross Blue Shield - New Mexico Policy CPCPLABO13 alerts

Get alerted when Policy CPCPLABO13 changes without checking for updates manually.

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Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyAllergen Testing

Policy CodePolicy CPCPLABO13

Change TypeMaterial and non-material edits (clarifications and consolidation)

Effective DateSep 5, 2025

Last ReviewApr 28, 2025

Next Review Date

Key ActionVerify product-specific coverage and any required authorization per plan documents before ordering allergen testing.

SourceLink

POLICY UPDATE CHANGES

Removed reimbursement guidance item #1 which was for guidance only.

Edited reimbursement statement #3 for clarity regarding annual re-testing for food allergens in children and adolescents.

Coverage and Reimbursement Criteria

Reimbursable testing criteria

Covered when ALL of the following are met

Specific IgE testing: Specific IgE in‑vitro allergy testing may be reimbursable when limited to allergens chosen for testing based on an individual's history, physical examination, and environment.up to 20 per year

Testing must be individualized and documented; applies to specific IgE in‑vitro assays limited to selected allergens.

Total serum IgE: In‑vitro testing for total serum IgE may be reimbursable for individuals with moderate to severe asthma or for individuals with signs or symptoms of allergic bronchopulmonary aspergillosis.

Clinical indication required (either moderate to severe asthma OR suspected allergic bronchopulmonary aspergillosis).

Annual food allergen retesting in children/adolescents: To monitor for allergy resolution in children and adolescents with an initial positive food allergen result(s), annual re‑testing for the same food allergen(s) may be reimbursable.annual

Limited to monitoring after an initial positive food allergen test; routine re‑testing otherwise is not reimbursable.

The following laboratory assays are explicitly excluded from reimbursement under this policy: the Antigen Leukocyte Antibody test (ALCAT) is not reimbursable. For individuals with signs or symptoms of allergies, basophil activation flow cytometry and in‑vitro testing of IgG, IgA, IgM, and/or IgD are not reimbursable. In‑vitro bead‑based epitope assays (for example, VeriMAP Peanut Dx) are not reimbursable. Additionally, qualitative specific IgE multi‑allergen screens that do not identify a specific allergen are not reimbursable.

Routine re‑testing for the same allergens in the absence of a new clinical presentation is not reimbursable. An exception applies for pediatric food allergy monitoring: to monitor for allergy resolution in children and adolescents with an initial positive food allergen result(s), annual re‑testing for the same food allergen(s) may be reimbursable.

Procedure and Laboratory Codes

Procedure / Laboratory Codes listed in policymixed

82784
82785
82787
83516
86001
86003
86005
86008
88184
88185

1–10 of 12

1/2

Provider Requirements and Billing Guidance

Prior Authorization

Verify coverage / authorization

Verify product-specific coverage and any required prior authorization with the member's plan before ordering allergen testing. Coverage, limits, and authorization requirements vary by product and may affect reimbursement.

Providers must check member benefit documents and prior authorization portals before testing
Plan documents and provider contracts govern when in conflict with this policy

Documentation Required

Provider action — documentation & billing

Providers should document clinical history, physical exam findings, and the specific allergens or clinical question that justifies testing. Submit supporting medical records when requested to substantiate medical necessity and to respond to claim reviews.

Use HIPAA-compliant code sets (CPT, HCPCS, ICD-10) and follow industry coding guidelines

Key Definitions

Specific IgE assay — definition and reimbursement rule

DefinitionAssay measuring allergen-specific IgE antibodies in serum; reimbursable when testing is limited to allergens selected based on the individual's history, physical examination, and environment.

Reimbursement thresholdUp to 20 allergen-specific IgE antibody tests per member per year when selection is individualized and documented.

Documentation requirementAllergen selection must be based on documented history, physical exam, and environmental exposure to support medical necessity.

Related reimbursable situationsTotal serum IgE may be reimbursable for moderate to severe asthma or suspected allergic bronchopulmonary aspergillosis (separate criterion).

LimitationsNot all products may apply; providers should verify product-specific coverage and applicable plan documents before ordering.

Background and Scope

Allergen testing comprises both skin testing and in‑vitro assays that measure allergen‑specific and total serum IgE to identify allergic sensitization. Per policy, specific IgE in‑vitro testing may be reimbursable when limited to allergens selected based on the individual’s history, physical examination, and environment (up to 20 allergen‑specific antibodies per year). Total serum IgE testing may be reimbursable when clinically indicated, for example in individuals with moderate to severe asthma or with signs or symptoms of allergic bronchopulmonary aspergillosis.

Policy Changes and Revision Notes

2025-04-28revisedLatest

Reimbursement Information updated: removed reimbursement guidance item #1 (guidance-only) and edited reimbursement statement #3 for clarity regarding annual re-testing for food allergens in children/adolescents; references revised and literature review documented.

2024-04-29revised

Document updated with literature review; reimbursement statement #3 edited for clarity and prior items #7 and #8 were combined into a statement clarifying basophil activation flow cytometry and in‑vitro testing of IgG/IgA/IgM/IgD are not reimbursable for individuals with signs or symptoms of allergies; references revised.