Allergy Testing

POLICY NUMBER

L.2.01.428

DESCRIPTION

Allergic or hypersensitivity disorders may be manifested by generalized systemic reactions as well as localized reactions in any organ system of the body. The reactions may be acute, subacute or chronic, immediate or delayed, and may be caused by numerous offending agents; e.g., pollen, molds, dust, mites, animal dander, stinging insect venoms, foods and drugs.

The optimum management of the allergic patient should include a careful history and physical examination and may include confirming the cause of allergic reaction by information from some of the testing methods outlined below. Once the agent is identified, treatment is provided by avoidance, medication or immunotherapy.

The following allergy tests are available in the diagnosis of the allergic patient:

1.  Direct Skin Test

• Percutaneous (scratch, prick or puncture)

• Intracutaneous (intradermal)

2.  Patch Test (Application Test)

This test modality identifies allergens causing contact dermatitis. The suspected allergens are applied to the patient's back under dressings and allowed to remain in contact with the skin for 48 hours. The area is then examined for evidence of delayed hypersensitivity reactions.

3.  Photo Patch Test

This test reflects contact photosensitization. A patch of skin is applied with the suspected sensitizer for 48 hours. If no reaction occurs, the area is exposed to a dose of ultraviolet light sufficient to produce inflammatory redness of the skin. If the test is positive, a more severe reaction develops at the patch site than on surrounding skin.

4.  Specific IgE In Vitro Tests:

• Radioallergosorbent Tests (RAST)

• Multiple Radioallergosorbent Tests (MAST)

• Fluorescent Allergosorbent Test (FAST)

• Enzyme-linked Immunosorbent Assay (ELISA)

These tests detect antigen-specific IgE antibodies in the patient's serum.

5.  Total Serum IgE Concentration

This testing modality is not indicated in most allergic patients, but may be indicated for those patients suspected of having allergic bronchopulmonary aspergillosis, immune deficiency disease characterized by increased IgE levels; (e.g., Wiskott-Aldrich syndrome, hyper-IgE staphylococcal abscess syndrome), IgE myeloma or pemphigoid.

6.  Certain Bronchial Challenge Tests

Histamine or methacholine is used to perform this test when it is necessary to determine if the patient has hyper-responsive airways. Volatile chemicals are used to perform the test when the allergy is encountered in an occupational setting.

7.  Double Blind Food Challenge Test

With this test, the patient ingests the food to which sensitivity is suspected. Both the patient and the physician are "blinded." This is usually done at home, but in some instances of extreme suspected hypersensitivity, it may be performed in the office setting.

8. Serial Endpoint Testing (SET)

Serial endpoint testing (SET) is a form of intradermal skin testing that uses increasing doses of antigen to determine the concentration at which the reaction changes from negative to positive (the "endpoint"). The test has been used for diagnosing allergic disorders, and is a potential alternative to other diagnostic tests such as skin prick testing (SPT) or in vitro testing for this purpose. Also SET has been used to guide the initiation of immunotherapy, by using the endpoint dilution as the starting antigen dose.

POLICY

Allergy Testing

Specific allergy testing may be considered medically necessary for individuals with clinically significant allergic history of symptoms when all of the following criteria are met:

• Symptoms are not adequately controlled by empiric conservative therapy; and

• Testing must correlate specifically to the individual’s history, risk of exposure; and

• Physical findings; and

• Test technique and/or allergens tested must have proven efficacy demonstrated through scientifically valid studies published in the peer-review literature.

Allergy testing may be considered medically necessary in the diagnosis of allergies utilizing the following techniques:

1.  Direct Skin Tests

The number of tests required may vary widely from patient to patient, depending upon the patient's history. There is a limit of 50 percutaneous and up to 20 intracutaneous skin tests per day.

A test is defined per antigen, not per injection of antigen (added 4/28/00).

2.  Patch Test (Application Test)

3.  Photo Patch Test

4.  Specific IgE In Vitro Tests:

• Radioallergosorbent Tests (RAST)

• Multiple Radioallergosorbent Tests (MAST)

• Fluorescent Allergosorbent Test (FAST)

• Enzyme-linked Immunosorbent Assay (ELISA)

These tests detect antigen-specific IgE antibodies in the patient's serum. They are considered medically necessary only once when testing for: inhalant allergens, (pollens, molds, dust, mites, animal danders), foods, insect stings, and other allergens such as drugs, when direct skin testing is impossible due to extensive dermatitis or marked dermatographism.  Also appropriate in children less than four years of age or if the patient's symptoms are life threatening (ie, suspected peanut allergy).

5.  Total Serum IgE Concentration

6.  Certain Bronchial Challenge Tests

If dust, ragweed or other common allergens are the suspected cause of the problem, this test is not medically necessary, since skin tests can be used in these situations.

7.  Double Blind Food Challenge Test

Clinician-supervised oral food challenges (OFCs) may be considered medically necessary for the diagnosis of food-allergic disease when ONE of the following clinical settings is present:

• To allow expansion of the diet when several foods are under consideration as a cause of symptoms, based upon history, positive specific IgE tests, and resolution of symptoms after elimination of all the suspected foods; or

• To evaluate foods that were removed from the diet or not introduced into the diet based primarily upon positive allergy tests; or

• When a food is highly suspected to have caused a significant acute allergic reaction, but specific IgE testing is negative; or

• When a food is highly suspected as an allergen, but elimination has not resulted in symptom resolution; or

• If tests for specific IgE are not relevant (eg, food protein-induced enterocolitis syndrome) or only partly relevant (eg, atopic dermatitis or eosinophilic esophagitis) to the illness.

8.  Serial Endpoint Testing (SET)

Serial endpoint testing (SET) may be considered medically necessary for the determination of a safe starting dose for testing or immunotherapy when there is potential for the specific allergen in question to produce a severe systemic allergic reaction or anaphylaxis (i.e., chemicals, drugs, bee venom or peanuts).

Repeat Allergy Testing

Repeat skin testing is considered medically necessary when there is clear documentation to support the following indications:

In Children:

• Initially sensitive to food and indoor environmental exposures but later develop pollen and outdoor mold sensitivities; or

• Have one or more food allergies and require reevaluation to examine for resolution of their food allergy (see Policy Guidelines).

In Adults:

• To evaluate newly discovered purified or standardized allergens; or

• Have received three to five years of venom immunotherapy and require reevaluation for the resolution of the venom allergy; or

• Develop increased atopic symptoms suggesting new sensitizations.

In the absence of new clinical presentation, routine re-testing for allergies to the same allergens (except where specified above) is considered not medically necessary.

Investigational Services

The following allergy tests are considered investigational:

1. Provocative tests for food or food additive allergies

2. Nasal challenge test

3. Conjunctival challenge test (ophthalmic mucous membrane test)

4. Cytotoxic food tests

5. Rebuck skin window test

6. Passive transfer or P-X (Prausnitz-Küstner) test

Clinical ecology services may be billed as allergy services, and should be denied as investigational. These services involve the diagnosis and treatment of environmental illness, which is defined as multiple complex allergies or toxicities which are alleged to cause symptomatic involvement of the gastrointestinal, musculoskeletal, respiratory, or central nervous system. These symptoms result from continued exposure to atmospheric contamination or exposure to common foods which may have been treated with pesticides and herbicides.

Examples of non-covered items considered to be used for environmental medicine/clinical ecology include but are not limited to:

• Barrier cloth cover for mattresses

• Cold packs to keep antigens frozen

• Electric heater, mineral oil sealed, dimples

• Half-mask respirator with organic vapor cartridges

• Housecleaning services

• Mold plates

• Air filters, including portable air filter with air conditioner converter (HEPA)

• RainbowTM vacuum cleaner

• Syringes for anitgen injections

• Water service

POLICY EXCEPTIONS

None

POLICY GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Repeat Skin Testing in Children

Serial testing — The allergy specialist should evaluate the child at regular intervals to determine if the allergy has been outgrown. Reevaluation can be accomplished with in vitro and/or SPT and information on accidental exposures. Reevaluation is usually performed yearly; however, longer or shorter intervals may be more appropriate in some situations.

Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:

A.  consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and

B.  appropriate with regard to standards of good medical practice; and

C.  not solely for the convenience of the Member, his or her Provider; and

D.  the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.

For the definition of Medically Necessary, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

9/1992: Issued

2/1997: Revised: Limitation on number of tests; denial of repeat testing except in rare circumstances; moved two tests (nasal and conjunctival challenge) to Investigational list.

4/28/00 See clarification under POLICY.

5/23/2001: Code reference section updated; ICD-9 diagnosis codes 117.3, 496.7, and 708.3 deleted; non-covered codes table added.

11/2001: Reviewed by MPAC; SDET or Rinkel Method changed to covered.

2/11/2002: Investigational definition added.

4/18/2002: Type of Service and Place of Service deleted.

6/5/2002: Code Reference section updated.

6/12/2002: ICD-9 diagnosis code 117.3, 692.73 and 708.3 added, CPT code 95078 moved to covered.

11/3/2004: Code Reference section updated, CPT code 95078 description revised covered codes, ICD-9 diagnosis code range 477.0-477.9, 692.0-692.6, 692.72-692.74 listed separately covered codes, ICD-9 diagnosis 989.5 description revised covered codes, ICD-9 diagnosis code 692.84, E906.4, V15.01, V15.02, V15.03, V15.04, V15.05, V15.06, V15.07, V15.08, V15.09 added.

09/12/2006: Coding Updated. ICD-9 2006 revisions added to policy.

10/25/2006: Policy updated to include allergy testing limits are per day.

12/21/2006: Code reference section updated per the 2007 CPT/HCPCS revisions.

1/3/2007: Serial endpoint testing (SET) moved to investigational per BCBSA policy.

1/4/2007: Code reference section updated; CPT 95027 moved to non-covered; describes SET.

8/17/2007: Policy section partially re-written for clarity; no change in policy.

8/22/2007: Code reference section reviewed. CPT 95015 moved to non-covered; describes SET.

12/12/2007:Code reference section updated per the 2008 CPT/HCPCS revisions.

12/24/2008: Code reference section updated per the 2009 CPT/HCPCS revisions.

6/16/2009: Policy statement updated. Additional information regarding Serial Endpoint Testing (SET) added to the description section of the policy. Policy statement updated to include medically necessary indications for Serial Endpoint Testing (SET). CPT code 95027 moved to covered table.

6/24/2009: CPT code 95015 moved to covered table.

7/16/2009: Policy revisions approved by Medical Policy Advisory Committee (MPAC).

9/29/2009: Code reference section updated. Description revised for ICD-9 code V15.06. ICD-9 diagnosis code 995.2 deleted from covered table due to code was deleted as of 10-1-2006. CPT procedure code 95078 deleted from covered table due to code was deleted as of 12-31-2006.

03/22/2010: Code reference section updated. Code description revised for CPT code 82784. 

07/08/2010: Policy description unchanged. Policy statement regarding serial endpoint testing revised to change the term "systemic reaction" to "systemic allergic reaction." Intent of policy statement unchanged.

08/20/2011: Deleted information regarding leukocyte histamine release test (LHRT) and removed 86343 from the Code Reference section.

07/12/2012: Added the following to the Policy Exceptions section: Hood Container Corp Union and Non-Union plans do not have a limit on allergy injections and testing.

12/21/2012: Added the following new 2013 CPT codes to the Code Reference section: 95017, 95018, 95076, and 95079.

08/26/2015: Medical policy revised to add ICD-10 codes. Removed deleted CPT codes 95010, 95015, and 95075 from the Code Reference section.

04/13/2016: Policy guidelines updated to add medically necessary and investigative definitions.

06/07/2016: Policy number L.2.01.428 added.

02/20/2017: Added the following Policy Exception for State Health Plan (SHP) Members: The Plan will cover up to 50 percutaneous skin tests and up to 20 intracutaneous skin tests on a one time basis.

12/21/2017: Code Reference section updated to add new 2018 CPT code 86008. Revised descriptions for CPT codes 86003 and 86005 effective 01/01/2018.

11/30/2018: Policy Exceptions updated to remove the following statement: State Health Plan (SHP) Members: The Plan will cover up to 50 percutaneous skin tests and up to 20 intracutaneous skin tests on a one time basis.

03/17/2020: Code Reference section updated to add new CPT code 0165U, effective 04/01/2020.

06/25/2020: Code Reference section updated to revise code description for CPT 0165U and to add new CPT code 0178U, effective 07/01/2020.

12/22/2020: Code Reference section updated to revise description of CPT code 95070, effective 01/01/2021.

08/20/2024: Policy reviewed. Policy statements unchanged. Code Reference section updated to remove deleted CPT code 95071.

10/01/2025: Code Reference section updated to add new ICD-10 diagnosis codes Z91.0110, Z91.0111, Z91.0112, Z91.0120, Z91.0121, and Z91.0122.

03/12/2026: Policy updated to remove ICD-9 diagnosis codes.

04/01/2026: Update made to first medical policy statement to provide general guidelines for when allergy testing should be performed. Formerly stated: “The following allergy tests are considered medically necessary in the diagnosis of the allergic patient:” Update made to Double Blind Food Challenge Test criteria. Formerly stated: “This is usually done at home, but in some instances of extreme suspected hypersensitivity, it may be performed in the office setting. In the latter case, this is considered to be part of the office visit and no additional benefits are provided.” Update made to repeat skin testing in children to add reevaluation criteria for food allergies. Policy Guidelines updated to clarify pediatric reevaluation considerations. Criteria added to adult repeat allergy testing criteria to include “develop increased atopic symptoms suggesting new sensitizations.” Policy Exceptions updated. Sources updated.

SOURCE(S)

1. Commins, S. (2024, October 7). Food intolerance and food allergy in adults: An overview. (S. Sicherer, Ed.). UpToDate. Accessed January 2026.

2. Keet, C., & Wood, R. (2025, October 30). Food allergy in children: Prevalence, natural history, and monitoring for resolution. UpToDate. Accessed January 2026.

3. Kim, E., & Burks, W. (2025, May 12). Diagnostic evaluation of IgE-mediated food allergy. UpToDate. Accessed January 2026.

4. Kowal, K., & DuBuske, L. (2025, January 23). Overview of in vitro allergy tests. UpToDate. Accessed January 2026.

5. Sicherer, S. H. (2025, December 15). Oral food challenges for diagnosis and management of food allergies. UpToDate. Accessed January 2026.

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.

Medically Necessary Codes

Not Medically Necessary Codes

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