Billing and Coding: RAST Type Tests

This billing and coding guidance states that RAST test CPT 86003 is covered but limited to 30 occurrences per beneficiary per year; CPT 86001 and 86005 are not covered. Claims must include a valid ICD-10-CM diagnosis and, when applicable, the ordering/referring provider name and NPI; specific ABN procedures (Form CMS-R-131, appropriate GA/GX/GY/GZ modifiers, and occurrence code 32 for Part A) and documentation (assessment, history, test results, signed notes) are required. Limitation of liability and refund rules apply when denials are anticipated, while statutorily excluded or no-benefit-category tests and screening services are treated under separate rules.

"CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit."

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