T63.304D — Toxic effect of unspecified spider venom, undetermined, subsequent encounter
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.
- This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
- 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.
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).
4 Active Policies
A56559 — Billing and Coding: Allergy Skin Testing
A56612 — Billing and Coding: CT of the Head
L34417 — CT of the Head
L33417 — Allergy Skin Testing
Related Codes
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