CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLABO13

Allergen Testing

Sets Blue Cross Blue Shield New Mexico reimbursement criteria for in-vitro and related allergen testing and identifies tests that are not reimbursable; applies to providers submitting claims to BCBSNM and to member coverage as determined by plan documents.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyAllergen Testing

Policy CodePolicy CPCPLABO13

Change TypeRevised reimbursement language

Effective DateApr 12, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and be prepared to provide additional documentation on request; claims are subject to review and coding edits.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised for clarity and the literature review was updated when the policy was created/updated.

up to 20specific IgE reimbursable per year

10+non-reimbursable test types

1policy version

6/15/2023update history date

Allergen Testing Coverage Criteria

Allergen testing coverage criteria

Covered when ALL of the following apply as specified below:

ANY of the following

When skin testing is contraindicated (see Note 1)
In lieu of skin testing for an INITIAL allergy screen
When confirmation of sensitivity would impact treatment decisions for individuals whose skin test results are inconsistent with a history of an anaphylactic or other severe reaction to an allergen
When limited to allergens chosen based on individual history, physical examination, and environment

ALL of the following

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyAllergen Testing

Policy CodePolicy CPCPLABO13

Change TypeRevised reimbursement language

Effective DateApr 12, 2023

Next Review Date

Key ActionProviders must submit accurate documentation and be prepared to provide additional documentation on request; claims are subject to review and coding edits.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Documentation and Claims Review

Documentation Required

Documentation, coding, and claims review requirements

Providers must submit accurate documentation of services performed and submit claims using valid HIPAA‑approved code sets and industry standard coding guidelines. Claims are subject to code edit protocols and claim review; upon request, providers should supply any additional documentation to support the claim.

Use valid code combinations from HIPAA‑approved code sets (CPT, HCPCS, ICD‑10, NDC, UB, DRG) and follow industry coding guidelines.
Claims are subject to code edit protocols, claim review, provider contract terms, and clinical payment and coding policies.
Provide additional documentation upon request to support medical necessity and coding.

Definitions and Contraindications

inv-05: Plan documents govern

Governing documentsCertificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents

PrecedenceIf a conflict arises between a CPCP and any plan document under which a member is entitled to Covered Services, the plan document will govern

Provider contractsIf a conflict arises between a CPCP and any provider contract, the provider contract will govern

DiscretionBCBSNM may use reasonable discretion interpreting and applying this policy consistent with applicable plan documents

inv-06: Contraindications to skin testing

Skin conditionsPatients with dermatographism, urticaria, cutaneous mastocytosis, atopic dermatitis, or severe diffuse psoriasis

High-risk patientsPatients with poorly controlled asthma, history of severe reaction to minute amounts of allergen, cardiac arrhythmia, or unstable angina

Interfering medicationsPatients taking medications that may interfere with anaphylaxis treatment (e.g., beta-blockers, ACE inhibitors) or impair skin test sensitivity (e.g., tricyclic antidepressants, antihistamines)

Recent anaphylaxisPatients who have experienced an anaphylactic event within the past one month

Uncooperative patientsUncooperative individuals (e.g., small children, persons with mental or physical impairments) for whom testing cannot be safely or reliably performed

OpenPayer

Allergen Testing

Allergen Testing Coverage Criteria

Coding and Procedure Codes

Documentation and Claims Review

Definitions and Contraindications