L20.9 — Atopic dermatitis, unspecified
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.
- Supportive documentation evidencing the condition and treatment must be documented in the medical record and be available to the Contractor upon request.
- ICD-10-CM diagnosis codes supporting the medical necessity of the service must be submitted with each claim.
- High-utilization or repeat testing should include clinical justification in the record (for example, repeat testing due to unsatisfactory response to treatment) to support medical necessity.
Key Coverage Criteria
- Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
- Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
- Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
- Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
- 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.
10 Active Policies
AMBETTER-CP.MP.100 — Allergy Testing
AETNA-CPB-0174 — Pool Therapy, Aquatic Therapy or Hydrotherapy
AETNA-CPB-0241 — Extracorporeal Photochemotherapy (Photopheresis)
AETNA-CPB-0300 — Hair Analysis
AETNA-CPB-0355 — Extracorporeal Immunoadsorption (Prosorba Column)
Related Codes
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