A7023 — Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Evidence in the medical record that test technique and allergens tested have proven efficacy (peer-reviewed literature basis) when applicable.
- Clinical documentation demonstrating a clinically significant allergic history of symptoms and that symptoms are not adequately controlled by empiric conservative therapy.
- Documentation that testing correlates specifically to the member's history, risk of exposure and physical findings.
- For epicutaneous/intradermal testing: relevant clinical history indicating suspected IgE-mediated reaction to the targeted allergens (foods, hymenoptera, inhalants, specific drugs).
Key Coverage Criteria
- Intradermal (intracutaneous) testing when IgE-mediated reactions occur to hymenoptera venom allergy (stinging insects).
- Intradermal (intracutaneous) testing when IgE-mediated reactions occur to inhalants.
- Intradermal (intracutaneous) testing when IgE-mediated reactions occur to specific drugs (penicillins and macromolecular agents).
- Specific allergy testing is medically necessary for members with clinically significant allergic history of symptoms when: symptoms are not adequately controlled by empiric conservative therapy; testing correlates specifically to the member's history, risk of exposure and physical findings; and test technique/allergens tested have proven efficacy in peer-reviewed literature.
- Epicutaneous (scratch, prick or puncture) skin testing when IgE-mediated reactions occur to foods.
- Epicutaneous (scratch, prick or puncture) skin testing when IgE-mediated reactions occur to hymenoptera (stinging insects).
1 Active Policy
AETNA-CPB-0038 — Allergy and Hypersensitivity
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