Allergy Testing

This policy covers allergy testing (percutaneous/prick, intradermal, in vitro serologic, patch/photo, photo testing, and oral challenge) and allergen immunotherapy for diagnosis and treatment of immediate (IgE‑mediated) and delayed (cell‑mediated) hypersensitivity conditions such as allergic rhinitis, asthma, atopic dermatitis, hymenoptera venom allergy, and suspected food or drug allergies. Testing and treatment are limited to patients with clinically significant symptoms and antigens the member is reasonably likely to be exposed to, must be ordered/performed by licensed practitioners with percutaneous testing required before intradermal testing, unit limits follow state/CMS rules, and numerous alternative/unproven tests (e.g., ALCAT, applied kinesiology/NAET), certain antibody/nutrient/toxicant assays, and pharmacy‑managed sublingual immunotherapy are excluded or not medically necessary.

"Allergy testing to determine immunologic sensitivity for immediate (IgE-mediated) hypersensitivity."