Allergy testing (in vivo and in vitro) coverage policy
Defines medical necessity, covered and not-covered allergy diagnostic tests (skin tests, specific IgE serum tests, and select in vitro assays) for Medicare Advantage and Commercial products, unit limits per CPT for skin testing, documentation expectations, and coding exclusions.
No material clinical or coverage changes identified in this update.
Coverage Summary
Policy: Allergy testing (in vivo and in vitro) coverage for Medicare Advantage Plans and Commercial Products. Coverage stance: mixed — select serum IgE quantitative assays (CPT 86003, 86008) are covered when filed with a covered diagnosis, while several in vitro assays are identified as not covered / not medically necessary due to insufficient evidence. Payer: Blue Cross Blue Shield of Rhode Island (Medicare Advantage Plans and Commercial Products).