Pediatric Coding Alert

Question: When we perform allergy testing, we bill CPT 86003 . Should we instead use 95004?


North Carolina Subscriber
Answer: For allergy testing, you should probably use 95004 or 95010 instead of 86003.

When the pediatrician 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 as shown below: