Wiki Allergy Testing Medicare Denials

[JennMagg]

We just started seeing A TON of denials for allergy skin testing (CPT 95004) from Medicare. They said it's due to medical necessity/insufficient documentation and that we have been using non-covered ICD-10 codes since the LCD update on 7/11/2021 (L36241). I reviewed the updated LCD and can't figure out what has changed so that it's no longer covered. Of course, the ICD-10 used depends on the patient, but it's often in the J30.0 - J31.0 range. Does anyone have any insight on this? Anyone else experiencing this issue? Thanks!!

 

[Christal]

We just started seeing A TON of denials for allergy skin testing (CPT 95004) from Medicare. They said it's due to medical necessity/insufficient documentation and that we have been using non-covered ICD-10 codes since the LCD update on 7/11/2021 (L36241). I reviewed the updated LCD and can't figure out what has changed so that it's no longer covered. Of course, the ICD-10 used depends on the patient, but it's often in the J30.0 - J31.0 range. Does anyone have any insight on this? Anyone else experiencing this issue? Thanks!!

When we bill allergy testing we will bill with Z01.82 and what they are found allergic to (J30.1, J30.81, J30.89). If no allergy is detected we bill the Z01.82 with sign and symptoms. We bill up to 80 units for 95004 and up to 40 units for 95024.