Question: When we perform allergy testing, we bill 86003. Should we use 95004?
North Carolina Subscriber
Answer: For allergy testing, you should probably use 95004 or 95010.
When the dermatologist orders in vitro tests, such as RAST (radioallergosorbent tests), FAST (fluorescent allergosorbent tests) or ELISA (enzyme-linked immunosorbent assay), you should use 86003 (Allergen specific IgE; quantitative or semiquantitative, each allergen). To report the lab code, your office must analyze the specimen, not merely send it to a lab.
Most carriers, commercial and Medicare, will not pay for these tests except under certain conditions. Insurers may cover the tests when the patient is a child under 4.
If you instead perform percutaneous or intracutaneous allergy testing, you should assign the appropriate code from the allergy testing series (95004-95078).
For scratch, puncture or prick tests, report 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests) or 95010 (Percutaneous tests [scratch, puncture, prick] sequential and incremental, with drugs, biologicals or venoms, immediate type reaction, specify number of tests).
If you administer intradermal tests, you should instead assign 95015-95028. Choose the right allergy test code based on the type of test and the allergens:
