# Allergy Testing 95004



## deborah.jordan@dhcfp.nv.gov (May 2, 2017)

Looking to know how often/usual frequency this test is administered?   And what qualifications are needed to perform the test, vs. complete the test interpretation and report?


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## JenniferB7 (May 2, 2017)

The frequency is going to vary by patient, but each insurance payer will have different guidelines.  You will want to check with you payer policies for any frequency limits.  For example, one Medicare contractor (Novitas) states:

"Retesting with the same antigen(s) should rarely be necessary within a three-year period. Exceptions include young children with negative skin tests or older children and adults with negative skin tests, but persistent symptoms suggestive of allergic disease where skin tests may be repeated one year later. Claims for retesting within a three-year period should be submitted with documentation of the medical necessity. Testing done on separate days for different antigens is acceptable as long as the total number of tests done within any three-year period is not excessive (2 standard deviations above the national mean)."
(https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36241&ver=36&name=331*1&UpdatePeriod=711&bc=AQAAEAAAAAAAAA%3d%3d&#7)​
BCBS of CA states:

The number of tests required may vary widely from patient to patient, depending upon the patient’s history and geographical location. In general, 40 percutaneous or 20 intracutaneous tests may be required.  However, evaluation of inhalant allergy may require up to 70 prick/puncture tests followed by 40 intradermal tests, which are ordinarily performed when prick/puncture tests are negative. In most cases, fewer tests are required.
(https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Allergy_Testing.pdf#search=95004)​

With regards to your second question, there are no specific qualifications for administering an allergy test.  The American Academy of Allergy, Asthma and Immunology provides this clarification for staff testing (http://www.aaaai.org/ask-the-expert/staff-testing):

Q. I am looking for information on qualifications for interpreting allergy skin testing. If an unlicensed person performs the test, is it acceptable to train them to interpret the test? Or is there a position statement that I can read stating it is not acceptable? How does this work in allergy practices?

A: I am not aware of any specific requirements listed for personnel designated to apply and interpret allergy skin tests. However, in my opinion, the requirement should be similar to those suggested for compounding allergy extracts. Below I have copied for you a quote regarding the suggested level of training for individuals who perform this task. The source of this quote is:

"Compounding personnel should be appropriately trained health professionals, including, but not limited to, registered nurses, licensed practical nurses, medical technicians, medical assistants, physician assistants, advanced practice nurses, and physicians."

The reliability and interpretation of the prick/puncture test is heavily dependent on the skill and interpretation of the individual tester, the reliability of the test instrument, the color of the skin, the status of skin reactivity on the day of the test, potency and stability of test extracts, especially the optimum concentrations used for the test, and experimental differences between duplicate prick tests.13,19,30 Appropriate proficiency test methods for evaluating accuracy, precision, and reproducibility of skin testing are encouraged in the training of personnel.

I hope this information is of help to you and your patients."

All my best.
Dennis K. Ledford, MD, FAAAA​
According to the CPT Assistant, which provides clarification on CPT coding, the physician must do the interpretation and document the findings (report).   
CPT Assistant Archives - Allergy Testing (Code 95004, 95024, 95027) and E/M Reporting (May 2010)  

"According to the CPT 2008 codebook, all of the allergy testing codes (95004, 95010, 95015, 95024, 95027, and 95028) include performance and physician interpretation of the testing, with preparation of a report by the physician."​
So, to bill CPT 95004, the person administering the test would need to be "appropriately trained" (usually this is an RN) and the physician would need to interpret the testing and prepare a written report.


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