CurrentHumanaPolicy LAB2023008

Laboratory - Allergen Testing

Humana Medicare Advantage claims payment policy governing reimbursement for in‑vitro and related laboratory allergen testing for Medicare Advantage members; identifies which specific allergen laboratory tests are reimbursable or not reimbursable and notes applicability with respect to Original Medicare LCDs.

Policy Summary

PayerHumana

PolicyLaboratory - Allergen Testing

Policy CodePolicy LAB2023008

Change TypeNo material changes

Effective Date04/2023

Next Review Date12/2025

Key ActionReimburse specific in‑vitro IgE testing (86003, 86008) up to 20 allergen specific antibodies per year for listed clinical indications.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

20maximum allergen specific IgE tests reimbursed per year

multiplespecific CPT codes listed as NOT reimbursable

manyOriginal Medicare LCDs referenced

severalspecific CPT codes described

Coverage Criteria

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.

Reimbursable and non‑reimbursable test criteria

Humana reimburses certain in‑vitro IgE tests for specified clinical indications and excludes reimbursement for several other laboratory allergen tests.

ALL of the following

Reimbursable tests
- Specific immunoglobulin E (IgE) in‑vitro allergy testing (CPT 86003, CPT 86008) is reimbursable, up to 20 allergen‑specific antibodies per year, when ordered for at least one of the following conditions: Asthma; Pruritus and dermatitis; Suspected allergen‑induced chronic rhinitis; Suspected allergy to specific drugs; Suspected food allergy; Suspected insect venom allergy; Urticaria.
- In‑vitro testing for total serum IgE (CPT 82785) is reimbursable when ordered for at least one of the following conditions: Chest or joint pain; Coughing up of mucous plugs; Fatigue; Fever; Headaches; Hemoptysis; Moderate or severe asthma; Skin lesions; Unintentional weight loss; Wheezing.
Not reimbursable tests
- In‑vitro testing of allergen specific or non‑specific IgG, IgA, IgM, or IgD (CPT 82784, 82787, 86001) is NOT reimbursable.
- Basophil activation flow cytometry testing (BAT) for measuring hypersensitivity (CPT 88184, 88185) is NOT reimbursable.
- In‑vitro allergen testing using bead‑based epitope assays (for example, VeriMAP™ Peanut Dx - CPT 0165U, CPT 0178U) is NOT reimbursable.
- In‑vitro testing of allergen non‑specific IgE using a qualitative multi‑allergen screen (CPT 86005) is NOT reimbursable.
- The Antigen Leukocyte Antibody Test (ALCAT) (CPT 83516) is NOT reimbursable.
Payment criteria for several codes may be subject to exceptions in specific Medicare jurisdictions and may be governed by contractor Local Coverage Determinations (LCDs) cited in the policy.

Max tests: Specific IgE testing reimbursed up to 20 allergen‑specific antibodies per year when criteria above are met.

Informational references only

This excerpt contains literature and guideline references that inform coverage policy but does not itself state explicit coverage criteria; consult the full policy for definitive coverage rules and coding.

ALL of the following

Selected references and guidelines cited as background for the policy include: Hemmings et al., 2018 (Basophil Activation Test review); Hoffmann et al., 2015 (clinical utility of BAT) ; Knight et al., 2018 (comparison of specific IgE and skin prick tests); and multiple systematic reviews and guideline documents.
Clinical practice guidelines and consensus reports referenced include: NASEM 2016 (food allergy assessment); NICE guidance on food allergy in under‑19s (2011) and ImmunoCAP ISAC 112 for multiplex testing (2020); NICE asthma guidance (2021); WAO/EAACI position papers and other specialty practice parameters.
Additional cited studies address diagnostic accuracy and applications of BAT, component‑resolved diagnostics, concordance of skin prick and serum‑specific IgE, and other evaluations relevant to allergen testing and interpretation.

Coding and Billing

Codes referenced in policyCPT | HCPCS | mixed

82784	Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each
82785	Gammaglobulin (immunoglobulin); IgE
82787	Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each
83516	Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method
86001	Allergen specific IgG quantitative or semiquantitative, each allergen
86003	Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each
86005	Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card)
86008	Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each
88184	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
88185	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker

1–10 of 12

1/2

No CPT/HCPCS codes listed in this excerptmixed

No codes listed

Max allergen-specific IgE tests per year

Maximum reimbursable allergen‑specific IgE tests per yearUp to 20 allergen specific antibodies per year

Applicable CPT codes for specific IgE in‑vitro testing86003, 86008

Clinical indications coveredAsthma; Pruritus and dermatitis; Suspected allergen‑induced chronic rhinitis; Suspected allergy to specific drugs; Suspected food allergy; Suspected insect venom allergy; Urticaria

(unnamed key/value entry from inventory)

Placeholder referenceThis key/value entry is reserved for additional coding thresholds or notes; see referenced literature and guideline citations for context.

Informational citations availableMultiple literature and guideline references listed in the policy may inform future threshold updates (see policy citations).

ActionConsult full policy document for finalized coding or threshold details before billing or prior authorization actions.

Provider Actions and Billing Impact

Billing Rule

Reimbursable in‑vitro IgE testing — Specific IgE (86003, 86008)

Specific immunoglobulin E (IgE) in‑vitro testing (CPT 86003, 86008) is reimbursable up to 20 allergen‑specific antibodies per year for listed clinical conditions. Use these billing rules when submitting claims and ensure documentation supports one of the qualifying diagnoses.

Affected codes: CPT 86003, CPT 86008
Limit: ≤ 20 allergen specific antibodies per year
Qualifying conditions include: asthma; pruritus and dermatitis; suspected allergen‑induced chronic rhinitis; suspected allergy to specific drugs; suspected food allergy; suspected insect venom allergy; urticaria

Denial Risk

Non‑reimbursable tests — IgG/IgA/IgM/IgD, BAT, bead‑based assays, qualitative multi‑allergen IgE

The following in‑vitro tests are NOT reimbursable. Submissions for these tests are at high risk of denial; do not bill as covered services. Ensure claims and documentation reflect alternative accepted testing methods when applicable.

Non‑reimbursable: allergen specific IgG/non‑specific IgG (CPT 82784, 82787)
Non‑reimbursable: IgA, IgM, IgD in allergy evaluation (CPT 86001)
Non‑reimbursable: Basophil activation flow cytometry testing (BAT) (CPT 88184, 88185)
Non‑reimbursable: Bead‑based epitope assays (e.g., VeriMAP™ Peanut Dx) (CPT 0165U, 0178U)
Non‑reimbursable: Qualitative multi‑allergen non‑specific IgE screen (CPT 86005)
Non‑reimbursable: Antigen Leukocyte Antibody Test (ALCAT) (CPT 83516)

Note

Background references

Selected clinical and review references relevant to basophil activation testing, specific IgE testing, and allergy diagnostic methods to inform clinical justification and provider education.

Hemmings O, Kwok M, McKendry R, Santos AF. Basophil Activation Test: Old and New Applications in Allergy. Curr Allergy Asthma Rep. 2018;18(12):77. DOI:10.1007/s11882-018-0831-5

Definitions

Specific IgE (in‑vitro) testing

DefinitionLaboratory measurement of allergen specific immunoglobulin E (IgE) antibodies performed in vitro to evaluate allergic conditions.

CPT codes86003 (allergen specific IgE; crude extract, each); 86008 (allergen specific IgE; recombinant or purified component, each)

Reimbursement noteSpecific IgE in‑vitro testing (86003, 86008) is reimbursable up to 20 allergen specific antibodies per year for listed clinical indications.

Basophil Activation Test (BAT)

Test descriptionBasophil Activation Test (BAT) — flow cytometry‑based assay to measure hypersensitivity (cell surface/cytoplasmic markers).

CPT references88184 (flow cytometry, technical component only; first marker); 88185 (each additional marker)

Reimbursement stanceBasophil activation flow cytometry testing (BAT) is identified in the policy as NOT REIMBURSABLE.

Bead‑based epitope assays (VeriMAP™)

Test descriptionBead‑based epitope assays (proprietary peanut assays) used to quantify multiple epitopes for peanut allergy assessment.

HCPCS / Proprietary codes0165U — VeriMAP™ Peanut Dx; 0178U — VeriMAP™ Peanut Sensitivity

Reimbursement stanceBead‑based epitope assays (e.g., VeriMAP™) are identified in the policy as NOT REIMBURSABLE.

ALCAT

Test nameALCAT — Antigen Leukocyte Antibody Test

CPT reference83516 — Immunoassay for analyte other than infectious agent antibody or antigen; qualitative or semiquantitative, multiple step

Reimbursement stanceALCAT (CPT 83516) is identified in the policy as NOT REIMBURSABLE.

Basophil activation test (BAT) — literature context

Assay roleBasophil activation test (BAT) is an in vitro assay used in the literature for diagnosis and monitoring of allergic disease; parameters may reflect severity and reaction thresholds.

Clinical evaluationLiterature discusses BAT as both a potential clinical diagnostic tool and as a specialist/research tool under evaluation for routine clinical application.

Policy stanceDespite investigational/diagnostic discussion in literature, BAT is designated NOT REIMBURSABLE in this payment policy.

Multiplex allergen testing

Example platformImmunoCAP ISAC 112 (multiplex allergen testing) referenced in NICE guidance and policy citations.

Clinical contextMultiplex allergen testing platforms evaluate multiple allergen components simultaneously and have been the subject of health‑technology assessments (e.g., NICE DG24).

Policy noteMultiplex platforms are discussed in the policy's references; applicability and reimbursement depend on specific test codes and clinical indications.