H10.419 — Chronic giant papillary conjunctivitis, unspecified eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Policy references and complements Local Coverage Determination L33417 for Allergy Skin Testing; full LCD and policy text required to determine specific documentation and billing rules.
- Documentation of documented IgE-mediated reactions is required for covered testing of inhalants, foods, Hymenoptera, and specific drugs.
- A complete history and physical examination documenting signs/symptoms and correlation to the antigens tested must be in the medical record.
- For intradermal testing, the clinician should document narrowing of the investigation and that the minimal number of skin tests necessary for diagnosis was performed.
Key Coverage Criteria
- Allergy skin testing is covered when the patient presents with a clinically significant allergic history or symptoms not controllable by empiric conservative therapy.
- Testing is covered only when the test selection, technique, and interpretation specifically correlate with and are justified by a complete history and physical examination.
- Only test techniques and allergens with proven efficacy demonstrated in peer-reviewed medical literature are covered.
- Allergy testing is covered when the patient's environment provides a reasonable probability of exposure to the specific antigen tested.
- Medicare covers percutaneous (scratch/prick/puncture) testing for documented IgE-mediated reactions to inhalants.
- Medicare covers percutaneous testing for documented IgE-mediated food allergies when clinical presentation suggests significant IgE-mediated reaction (e.g., angioedema, urticaria, or anaphylaxis after ingestion).
3 Active Policies
A56424 — Billing and Coding: Allergy Immunotherapy
A56559 — Billing and Coding: Allergy Skin Testing
L33417 — Allergy Skin Testing
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