Description

An allergic reaction can be described as an abnormally high sensitivity to certain substances, such as pollens or foods. Any substance that can trigger an allergic reaction is called an allergen. To determine which specific substance is triggering the allergies, an allergist/immunologist will conduct allergy testing, which involves scratching, pricking or puncturing the skin while injecting allergens under the skin. Once the allergy causing agent is identified, treatment may be provided.

Examples of allergy testing methods include, but may not be limited to, the following:

• Bronchial challenge test – These tests are utilized to assess airway responsiveness. Histamine or methacholine are used to perform this type of testing. The individual inhales concentrations of the suspected substance while gradually increasing the concentrations. Pulmonary function tests are performed before and after the inhalations to measure the response. A drop in function signals an allergic reaction and possibly allergic asthma.
• Component-resolved diagnostics – An allergy diagnostic test that utilizes quantitative, semiquantitative, recombinant or purified components to reportedly detect specific IgE sensitivity to individual allergen molecules or multiple epitopes. When utilized for food allergies (e.g., VeriMAP), the attempt is to develop a molecular sensitization profile to supposedly determine the risk of severity of allergic reactions to certain foods (e.g., dairy, peanuts, soy). However, the gold standard continues to be an oral food challenge. (Refer to Coverage Limitations section)
• Double-blind, placebo-controlled oral challenge test – These tests are required to confirm suspected gastrointestinal or systemic symptoms occurring after ingestion of food, food additives and some medications.
• Intradermal dilutional testing (IDT) (also known as skin endpoint titration [SET]) – IDT involves consecutive testing with several dilutions of the selected allergen or mixture of allergens utilized to identify the lowest dilution that produces a positive skin reaction.
• Intradermal (intracutaneous) testing – Purified allergen is injected into the skin of the arm. It is usually performed to determine allergies to insect venom or penicillin.
• Multiple panel testing (e.g., Precision Allergy 88 [Serum], Precision Dietary SIgA [Saliva], Precision Airborne Allergy [Serum]) – This type of testing is designed to assess a large variety of allergens (e.g., airborne such as dust or mold, foods) utilizing either saliva or serum samples. The panels reportedly test for, but may not be limited to, IgA, IgG, IgG4 as well as complementary components such as C3d. (Refer to Coverage Limitations section)
• Patch testing – The patch test is completed by placing patches containing small doses of the selected allergen onto the skin. This test checks for a delayed type of allergic reaction, which occurs 2 to 7 days after exposure. If the results are positive, contact dermatitis (skin inflammation) will result.

Allergy Testing Effective Date: 03/01/2023

Revision Date: 03/01/2023

Review Date: 03/01/2023

Policy Number: HUM-0441-025

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Patch testing is useful for diagnosing metal, latex or chemical allergies.

Photo patch testing

Photo patch test is completed by placing identical allergens on 2 separate sites on the back. If there is no reaction to the allergens after 48 hours, 1 site is exposed to ultraviolet (UV) light; the reaction is positive when an allergic reaction occurs only on the UV exposed area.

Puncture, prick or scratch test (percutaneous)

This is the most commonly performed method of testing. Tiny drops of purified allergen extracts are scratched or pricked into the skin’s surface. A small swelling on the skin (wheal) indicates an allergic reaction. This test is usually performed for pollen, mold, pet dander, dust mites, food, penicillin and insect venom.

Specific IgE in vitro test (radioallergosorbent test [RAST], multiple antigen simultaneous test [MAST], fluorescent allergosorbent test [FAST] ImmunoCap Specific IgE)

These tests are designed to detect the antigen-specific IgE antibodies in an individual’s serum. This is useful when testing for inhalant allergens such as pollens, molds, dust mites and animal dander. It is also used to detect allergies to food and insect stings.

Specific IgE immunoassays may be preferable to skin testing in circumstances such as, but not limited to: in an individual with intensive dermatitis, severe dermatographism, generalized eczema, an individual who has been receiving long- acting antihistamines or receiving medications that may put them at undue risk when stopped, when evaluating cross-reactivity between insect venoms or as an adjunctive laboratory test for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic diseases.

Total serum IgE concentrations

(paper radioimmunosorbent test [PRIST], radioimmunosorbent test [RIST]) – This type of testing is less useful in assessing the risk of allergic disease, but may be indicated for an individual suspected of having allergic bronchopulmonary aspergillosis, eczema, hyper-IgE syndrome, certain stages of human immunodeficiency virus (HIV), IgE myeloma, graft versus host disease or immune deficiency diseases characterized by increased IgE levels (eg, Wiskott-Aldrich syndrome).

Allergy Testing Effective Date: 03/01/2023

Revision Date: 03/01/2023

Review Date: 03/01/2023

Policy Number: HUM-0441-025 Page: 4 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Coverage Determination

General Criteria for Allergy Testing

Humana members may be eligible under the Plan for allergy testing when the following criteria are met:

• Clinically significant allergic history or symptoms exist which are not controllable 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 medical studies published in peer-reviewed literature

Criteria for Specific Allergy Testing

Humana members may be eligible under the Plan for allergy testing using the following types of tests if the general criteria listed above is met:

• Bronchial challenge test for airway hyperactivity or to aid in the diagnosis of asthma; OR
• Intradermal dilutional testing (IDT) (also known as skin endpoint titration [SET]); OR
• Intradermal testing for delayed hypersensitivity of tuberculin type; OR
• Oral challenge testing including double-blind food challenge test; OR
• Paper radioimmunosorbent test (PRIST), radioimmunosorbent test (RIST) or immunoglobulin G (IGG1); OR
• Patch testing for allergic contact dermatitis (limited to 80 units); OR
• Percutaneous and intracutaneous skin testing (eg, scratch, prick, puncture) – percutaneous testing (limited to 80 units) and intracutaneous testing (limited to 50 units)*; OR
• Photo patch testing for photocontact sensitivity; OR

Allergy Testing Effective Date: 03/01/2023
Revision Date: 03/01/2023
Review Date: 03/01/2023
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• Specific IgE in-vitro allergy testing such as radioallergosorbent test (RAST), multiple antigen simultaneous test (MAST), fluorescent allergosorbent test (FAST) and ImmunoCap Specific IgE, in lieu of percutaneous prick testing (limited to 50 units) for the following indications:
  1. Clinical history is suggestive of an IgE-mediated allergy (eg, symptoms in the nose, lungs, throat, on the skin), but skin tests are negative; OR
  2. In an individual receiving skin test suppressive medication therapy that cannot be temporarily discontinued (eg, antidepressants, beta blockers); OR
  3. In an uncooperative individual (eg, small child, individual with mental or physical impairments); OR
  4. Presence of widespread skin disease (eg, dermatographism, ichthyosis or generalized eczema); OR

*Routine annual skin testing without a definite clinical indication is not considered medically necessary with the exception of venom skin tests, which may require a repeat test at 3-to-6-month intervals when the initial test is negative.

Coverage Limitations

Humana members may NOT be eligible under the Plan for allergy testing for any indications/tests other than those listed above including, but may not be limited to:

• Allergen specific immunoglobulin testing (eg, IgA, IgD, IgG, IgM) by any method (82784); OR
• Allergy testing and desensitization for poison ivy, oak and sumac; OR
• Allergy testing related to the diagnosis of autism (eg, food allergies for gluten, casein, candida and other molds)20; OR

Allergy Testing Effective Date: 03/01/2023
Revision Date: 03/01/2023
Review Date: 03/01/2023
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• Antigliadin antibodies; OR
• Applied kinesiology test; OR
• Body chemical analysis; OR
• Candida hypersensitivity syndrome test; OR
• Component-resolved diagnostics described as quantitative or semiquantitative allergen specific immunoglobulin testing, utilizing recombinant or purified components; individual antigen or multiple epitopes (86008, 0165U, 0178U); OR
• Conjunctival challenge testing (ophthalmic mucous membrane test); OR
• Cytotoxic food test (ALCAT testing, Bryan’s test); OR
• Electrodermal acupuncture test; OR
• Food specific IgG antibodies; OR
• Hair analysis; OR
• In vitro histamine release testing, such as leukocyte histamine release test (LHR); OR
• In vitro lymphocyte proliferation test; OR
• Iridology; OR
• Multiple panel testing (eg, Precision Allergy 88 [Serum], Precision Dietary SIgA [Saliva], Precision Airborne Allergy [Serum]) unless ALL tests within the panel relate to the health condition and affects clinical management decisions (for medically necessary testing within a panel, use above criteria in Coverage Determination that is applicable to the condition); OR
• Nasal challenge test (direct nasal mucous membrane test); OR

Allergy Testing Effective Date: 03/01/2023
Revision Date: 03/01/2023
Review Date: 03/01/2023
Policy Number: HUM-0441-025 Page: 7 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

• Nitric oxide expired gas determination (for information regarding coverage determination/limitations, please refer to Exhaled Breath Tests Medical Coverage Policy); OR
• Photo test; OR
• Provocative and neutralization tests (subcutaneous or sublingual); OR
• Reaginic pulse test; OR
• Testing of multiple chemical sensitivities or multiple environmental sensitivities

For Humana plans that exclude coverage of allergy testing not approved by the American Academy of Allergy Asthma & Immunology (AAAAI), these technologies would be excluded by the certificate language. In the absence of an exclusion in the certificate, these are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Background

Additional information about allergies may be found from the following websites:

• American Academy of Allergy Asthma & Immunology
• National Institute of Allergy and Infectious Diseases
• National Library of Medicine

Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Allergy Testing Effective Date: 03/01/2023
Revision Date: 03/01/2023
Review Date: 03/01/2023
Policy Number: HUM-0441-025 Page: 8 of 18

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

Provider Claims Codes

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Not Covered if used to report any testing outlined in Coverage Limitations section

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References

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• Allergy Testing Effective Date: 03/01/2023
  Revision Date: 03/01/2023
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  Policy Number: HUM-0441-025 Page: 11 of 18
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Allergy Testing Effective Date: 03/01/2023
Revision Date: 03/01/2023
Review Date: 03/01/2023
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