HIGHMARK COMMERCIAL MEDICAL POLICY - PENNSYLVANIA

 
 

Medical Policy:
L-3-024
Topic:
In Vitro Allergy Testing
Section:
Laboratory
Effective Date:
January 1, 2018
Issued Date:
January 28, 2019
Last Revision Date:
January 2019
Annual Review:
January 2019
 
 

In vitro allergy testing determines whether a patient's serum contains immunoglobulin E (IgE) antibodies against specific allergens of clinical importance. The radioallergosorbent (RAST) test was developed for in vitro (blood) measurement of specific IgE in a patient’s serum. There are several other tests that employ the same principle using different detection systems.

Policy Position

In vitro allergy testing for IgE may be considered medically necessary when ANY of the following are met:

  • Direct skin testing is impossible due to an extensive dermatitis or marked dermatographism; or
  • Direct skin testing is contraindicated because of concomitant drug treatment (e.g., psychotropic drugs frequently have H1 blocking characteristics); or
  • When there is difficulty in testing uncooperative patients (e.g., small children or patients with mental or physical impairments); or
  • If direct skin testing has been inconclusive; or
  • As adjunctive tests for allergic bronchopulmonary aspergillosis or parasitic disease; or
  • Individuals who have a clinical history suggesting an unusually greater risk for anaphylaxis or who have had a previous systemic reaction to skin testing; or
  • For evaluation of cross-reactivity between insect venoms.

In vitro allergy testing for IgE exceeding 36 tests per year is considered not medically necessary.

In vitro allergy testing for IgE that does not meet the criteria of this policy is considered not medically necessary.

86003

86008

 

 

 

 

 

 




ELISA/ACT qualitative antibody testing is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

86353

86849

 

 

 

 

 




IgG ELISA, indirect method, is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.

86001




ALCAT (Antigen Leukocyte Cellular Antibody Test) allergy testing is considered experimental/investigational and, therefore, non-covered.  Scientific evidence does not demonstrate the usefulness of these tests.

83516




Related Policies

Refer to medical policy Z-26, Allergy Skin Testing, for additional information.


Place of Service: Inpatient/Outpatient

Experimental/Investigational (E/I) services are not covered regardless of place of service.

In vitro allergy testing is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.


The policy position applies to all commercial lines of business



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This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.

Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

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