The changes below will start on August 28, 2018.
Frequency of Allergy Studies
These changes are in accordance with policy from the Centers for Medicare & Medicaid Services (CMS):
Allergy studies (CPT codes 95004, 95017, 95018, 95024, or 95027) are allowed up to 137 tests within one year, which should cover all the percutaneous and intradermal tests for the patient's evaluation. Other regional CMS policies indicate that an evaluation may require up to 75 percutaneous tests for inhalant allergies, followed by up to 20 intracutaneous tests (performed when percutaneous tests are negative). Thirty tests may be needed for a combination of percutaneous and intracutaneous tests with venoms (CPT code 95017) and 12 tests may be needed for a combination of percutaneous and intracutaneous tests with drugs or biologicals (CPT code 95018).
Frequency of Preparation and Provision of Antigen Doses
This change is in accordance with the Joint Task Force on Practice Parameters commissioned by the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology.
The reporting and supervision of preparation and provision of single or multiple antigen doses (CPT code 95165) to a patient should not exceed 137 units per year. If CPT code 95165 is billed for additional units, it will be denied.