Z91.09 — Other allergy status, other than to drugs and biological substances
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and indicate the reason(s) the service was performed; claims without ICD-10-CM codes will be returned.
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of claim, report the symptoms that prompted the test.
- The name and NPI of the referring/ordering physician must be reported on the claim when required by the service.
Key Coverage Criteria
- RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
- CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
- Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
- Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
- Standard skin testing is the preferred method when allergy testing is necessary.
- When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
11 Active Policies
L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
A57472 — Billing and Coding: Allergy Immunotherapy
J05
A57473 — Billing and Coding: Allergy Testing
J05
L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
J05
L36402
Related Codes
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