Allergy Testing

Medically necessary allergy testing includes targeted in vivo skin tests (prick/puncture, intradermal, patch, photo-patch), organ challenge tests, oral food challenges when diagnosis is uncertain, and specific in vitro IgE assays when skin testing is impossible or unsafe; total IgE testing is limited to select conditions (e.g., ABPA, hyper-IgE syndrome, evaluation for omalizumab). Testing must be guided by a documented history and physical exam, use validated methods with controls, be performed by appropriately licensed/trained providers, and adhere to limits on test number (e.g., up to 70 prick, 40 intradermal, 80 patch tests) while avoiding routine indiscriminate or non-covered alternative diagnostic tests listed in the policy.

"Percutaneous prick/puncture (scratch, puncture, prick) skin testing is medically reasonable and necessary for evaluation of IgE-mediated hypersensitivity to inhalants, foods, Hymenoptera (stinging ..."