Primary Care Coding Alert

Question: When my family physician (FP) performs allergy testing (86003, 95004, 95024, 95027), we sometimes test for as many as 20 allergens. Numerous insurers pay for the first 14 tests but deny the rest. Why are payers denying these services?    

Florida Subscriber



Answer: Many insurers limit the number of allergy tests allowed based on conservative medical practices, which call for testing a judicious amount of allergens at a time. Allergy screening test literature supports, and the American Academy of Otolaryngic Allergy (AAOA) recommends, screening and billing for no more than 14 antigens (plus the appropriate controls) for an initial allergy evaluation, according to the AAOA Coding Advisory. "In most geographic regions, a range of up to 14 allergens is sufficient to check the most prevalent molds, dust components, grasses, trees, animals, and weeds," the bulletin states.

Therefore, if your FP performs additional tests, such as 86003 (Allergen specific IgE; quantitative or semiquantitative, each allergen), 95004 (Percutaneous tests [scratch, puncture, prick] with allergenic extracts, immediate type reaction, specify number of tests), 95024 (Intracutaneous [intradermal] tests with allergenic extracts, immediate type reaction, specify number of tests) or 95027 (Intracutaneous [intradermal] tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, specify number of tests), carriers that limit the number of tests billed at one time or within a certain number of years may deny the extra tests.

Practices that often exceed carrier limits may be flagged for an audit, the statement warns, so make sure to ask payers for their current allergy payment practices.