Billing and Coding: Allergy Testing

Medicare covers allergy testing when patients have clinically significant allergic symptoms and conservative therapy has failed; testing comprises cutaneous and mucous membrane tests plus physician history, exam, antigen selection, and interpretation. Each individual antigen/test must be billed as one unit (enter units on CMS-1500 Box 24G or EMC service field), E/M codes require a separately identifiable service with modifier -25, certain procedures (e.g., sublingual/neutralization tests, cytotoxic leukocyte tests, some challenge ingestion uses) are excluded, and testing integral to immunotherapy or rapid desensitization (including potency testing) is not separately reportable.

"Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed."

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