CurrentBlue Cross Blue Shield - OklahomaPolicy CPCPLAB013

Allergen Testing

Reimbursement and coding guidance for in‑vitro and related allergen testing services for Blue Cross Blue Shield of Oklahoma members; describes when specific IgE, total IgE, and other allergen tests are reimbursable or not and which procedures/codes are referenced.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyAllergen Testing

Policy CodePolicy CPCPLAB013

Change TypeRevised (non-material)

Effective DateJun 15, 2023

Next Review DateN/A

Key ActionProviders must submit accurate documentation and may be asked to provide additional documentation upon request; claims are subject to review.

SourceLink

POLICY UPDATE CHANGES

Reimbursement information revised for clarity and literature review updated with references added and removed.

20max IgE tests/year

11procedure codes listed

~10-20reference citations

severalnon-reimbursable tests

Allergen Testing Coverage Criteria

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Allergen testing coverage criteria

Covered when the following conditions are met:

ANY of the following

ALL of the following
- In lieu of skin testing for an INITIAL allergy screen
- When skin testing is contraindicated (see Note 1)
- When confirmation of sensitivity is needed because direct skin testing results are not consistent with a history of an anaphylactic or other severe reaction
- When testing is limited to allergens chosen based on an individual's history, physical examination, and environment

ALL of the following

Specific IgE in-vitro allergy testing: up to 20 allergen-specific antibodies per year may be reimbursable
Total serum IgE: reimbursable for individuals with moderate to severe asthma being considered for Xolair therapy
Total serum IgE: reimbursable for individuals suspected of having allergic bronchopulmonary aspergillosis
Re-testing to monitor allergy resolution in children/adolescents: annual re-testing for the same food allergen(s) may be reimbursable after an initial positive result

ALL of the following

In the absence of a new clinical presentation, routine re-testing for allergies to the same allergens (except where specified) is not reimbursable

ALL of the following

Antigen Leukocyte Antibody test (ALCAT) is not reimbursable
In-vitro testing of IgG, IgA, IgM, and/or IgD for evaluation of suspected allergy is not reimbursable
Basophil activation flow cytometry testing (BAT) is not reimbursable
In-vitro allergen testing using bead-based epitope assays (e.g., VeriMAP) is not reimbursable
Specific IgE multi-allergen screens that do not identify a specific allergen are not reimbursable

Skin testing contraindications (see Note 1)

Procedure Codes and Limits

Allergen testing procedure codes mentionedmixed

82784
82785
82787
83516
86001
86003
86005
86008
88184
88185

1–10 of 12

1/2

Maximum allergen-specific IgE per year — numeric limit for reimbursement

Annual maximum reimbursable allergen-specific IgE testsUp to 20 allergen-specific IgE antibody tests per year

ScopeApplies to specific IgE in‑vitro testing when used consistent with policy criteria (e.g., initial screen, contraindication to skin testing, confirmation for severe reactions, or targeted testing based on history/exam)

Counting methodLimit applies to allergen-specific IgE antibodies rather than total serum IgE or non-reimbursable assays

Documentation, Claim Review, and Reimbursement Notes

Documentation Required

Submit accurate documentation and respond to claim review requests

Providers are responsible for submission of accurate documentation of services performed. Claims are subject to code edit protocols and claim review against benefit terms, provider contract language, medical and clinical payment and coding policies, and coding software logic; upon request, providers must submit additional documentation to support the claim.

Submit claims using valid HIPAA-approved code sets and industry standard coding guidelines (CPT, HCPCS, ICD-10, NDC, DRG, CMS NCCI/CCI rules).
Be prepared to provide additional documentation upon request to support medical necessity or coding decisions.

Billing Rule

Reimbursement wording and literature review updated (6/15/2023)

The policy was updated on 6/15/2023: reimbursement information was revised for clarity and the literature review and references were updated.

Effective date of the update: 6/15/2023.
Changes include revised reimbursement wording and revisions to references (some added, others removed).

Definitions and Contraindications

Use and definition — Specific IgE in‑vitro testing as alternative to skin testing

DefinitionSpecific IgE in‑vitro allergy testing may be used in lieu of skin testing for an initial allergy screen, when skin testing is contraindicated, when confirmation is needed for severe reactions, or when testing is limited to allergens chosen based on an individual’s history, exam, and environment.

Primary use‑casesInitial screening instead of skin testing; confirmation of sensitivity when skin test results conflict with clinical history of severe/anaphylactic reaction; targeted testing based on history/exam/environment.

Associated limitsWhen reimbursable under these uses, specific IgE testing is subject to the annual limit (up to 20 allergen‑specific antibodies per year).

Situations where skin testing is contraindicated

Dermatologic contraindicationsPatients with certain skin conditions (e.g., dermatographism, urticaria, cutaneous mastocytosis, atopic dermatitis, severe diffuse psoriasis).

Medication interferencePatients taking medications that interfere with anaphylaxis treatment (e.g., beta‑blockers, ACE inhibitors) or that impair skin test sensitivity (e.g., tricyclic antidepressants, antihistamines).

High‑risk clinical statusPatients at high risk for testing (e.g., poorly controlled asthma, clinical history of severe reaction to minute allergen amounts, cardiac arrhythmia, unstable angina).

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

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

References — selected clinical guidelines and studies

Practice parameter on anaphylaxis (Ann Allergy Asthma Immunol 2015)Lieberman P. et al., Anaphylaxis—a practice parameter update 2015; Ann Allergy Asthma Immunol. 115(5):341-384. DOI:10.1016/j.anai.2015.07.019.

NICE guidance on food allergy and allergen testingNICE. Food allergy in under 19s: assessment and diagnosis (2011) and guidance on multiplex allergen testing (DG24).

Basophil activation test and diagnostic literatureSantos A.F. and colleagues; studies and reviews on BAT and diagnostic performance (J Allergy Clin Immunol; Clin Transl Allergy).

Systematic reviews and diagnostic accuracySoares‑Weiser K. et al., The diagnosis of food allergy: systematic review and meta‑analysis; Allergy. 2014.

Additional specialty resourcesWAO White Book on Allergy; international consensus statements and studies on skin prick test variability and patch testing (multiple citations).