Allergy and Hypersensitivity

Aetna covers specific allergy testing—primarily epicutaneous (scratch/prick/puncture) testing for IgE‑mediated food, hymenoptera, inhalant, and certain drug (penicillins/macromolecular) allergies and up to 80 patch tests—when the member has a clinically significant allergic history with symptoms uncontrolled by empiric therapy and testing directly correlates with history, exposure risk, physical findings, and uses validated test techniques/allergens. Intradermal testing is not appropriate for food allergy (high false positives/anaphylaxis), numeric limits apply (e.g., up to ~70 percutaneous/40 intracutaneous for inhalants; up to 14 SET titrations plus additional antigen/IDT injections when needed), SET cannot replace skin testing, and specific ICD‑10 exclusions (e.g., FPIES, IBS) apply.

"Allergenex Testing (Spiriplex microarray panel) — lack of evidence regarding clinical value."