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CPT 86001 Allergen specific IgG testingCPT 86005 Allergen specific IgE qualitative, multiallergen screenCPT 86006 Allergen specific IgE, multiallergen screenLast reviewed at VbBS in November 2017. Minutes indicate that the staff recommendation was accepted without significant discussion. HERC approved the recommendations without change. Serum allergy testingCode: 86008 Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, eachSimilar serum allergy test codes are diagnostic. These codes have never been reviewed to current HERC staff knowledge.86001 Allergen specific IgG quantitative or semiquantitative, each allergen86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each86005 Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card)Non-serum allergy testing (i.e. skin testing) is on lines 9,124,223,313,530,531,550,559,56695018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests95024-95028 Intracutaneous (intradermal) test, various types95044 Patch or application test(s) (specify number of tests)Lines containing food allergy diagnosesICD-10 T78.0 (Anaphylactic reaction due to food products) is on line 124 ANAPHYLACTIC SHOCK; EDEMA OF LARYNX AND THE 4 DYSFUNCTION LINESICD-10 T78.1XX (Other adverse food reactions, not elsewhere classified) is on line 543 SYMPTOMATIC URTICARIAICD-10 J30.5 (Allergic rhinitis due to food) is on line 559 ALLERGIC RHINITIS AND CONJUNCTIVITIS, CHRONIC RHINITISICD10 L27.2 (Dermatitis due to ingested food) is on line 566 DERMATITIS DUE TO SUBSTANCES TAKEN INTERNALLYICD-10 K52.2 (Food protein-induced enterocolitis syndrome) is on line 550 OTHER NONINFECTIOUS GASTROENTERITIS AND COLITISICD-10 K90.0 (Celiac disease) is on line 228 INTESTINAL MALABSORPTIONNote: celiac disease is diagnosed by intestinal biopsyICd-10 K90.41 (Non-celiac gluten sensitivity) is on line 658 GASTROINTESTINAL CONDITIONS WITH NO OR MINIMALLY EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARYBackground: Allergy testing can be conducted in several ways. The most common type of testing involves the suspected allergen(s) applied to the skin through a pin prick or scratch. If the patient is allergic to that substance, then the area becomes red and swells or otherwise shows a reaction. If a patient cannot have skin testing for some reason (severe skin disease, high risk of anaphylaxis, etc.), there are blood tests to test for allergen specific immune substances. These are generally IgE tests, which is the immunoglobulin related to allergy issues. Other policies:Aetna 2017: In vitro IgG antibody tests are considered experimentalIn Vitro IgE Antibody Tests (RAST, MAST,?FAST,?ELISA, ImmunoCAP) are considered medically necessary for 1) patients receiving skin test suppressive medication therapy that cannot be temporarily discontinued (eg, antihistamines or beta blockers); 2)?presence of widespread skin disease (eg, dermatographism, ichthyosis, intensive dermatitis?or generalized eczema); 3)?uncooperative patients (eg, small children, individuals with mental or physical impairments);?4)?when clinical history suggests an unusually greater risk of anaphylaxis from skin testing; 5) evaluating cross-reactivity between insect venoms; or 6) as an adjunctive laboratory test for disease activity of allergic bronchopulmonary aspergillosis?or certain?parasitic diseases?; and?testing is performed for any of the following indications: Allergic broncho-pulmonary aspergillosis (ABPA) and certain parasitic diseases; or Food allergy; or Hymenoptera venom allergy?(stinging insects); or Inhalant allergy; or Specific drugs.Wellmark 2017: The use of in vitro (blood) (86003) allergy testing for IgE should be limited to individuals where skin testing is not possible.Any IgG in-vitro assay used for evaluation is investigationalExpert society recommendations:American Academy of Allergy, Asthma & Immunology, 2014, Choosing Wisely:Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergyDon’t perform food IgE testing without a history consistent with potential IgE-mediated food allergy. False or clinically irrelevant positive allergy tests for foods are frequent. Indiscriminate screening results in inappropriate avoidance of foods and wastes healthcare resources. IgE testing for specific foods must be driven by a history of signs or symptoms consistent with an IgE-mediated reaction after eating a particular food. Ordering IgE testing in individuals who do not have a history consistent with or suggestive for food allergy based on history frequently reveals positive tests that are unlikely to be clinically relevant. Testing, when done, should be limited to suspected foods. The diagnostic utility of IgE testing for specific foods is optimal when a history compatible with or suggestive for the diagnosis of food allergy is present. In the absence of a compatible or suggestive history, the pre-test probability for a diagnosis of food allergy is low and a positive skin or in vitro IgE test does not establish a diagnosis of food allergy. Skin testing or serum testing for specific-IgE to food antigens has excellent sensitivity and high negative predictive value, but has low specificity and low positive predictive value. Considering that 50 to 90 percent of presumed cases of food allergy do not reflect IgE-mediated (allergic) pathogenesis and may instead reflect food intolerance or symptoms not causally associated with food consumption, ordering panels of food tests leads to many incorrectly identified food allergies and inappropriate recommendations to avoid foods that are positive on testing.NICE 2017Includes serum IgE testing for patients undergoing evaluation for food allergiesSicherer 2012, American Academy of Pediatrics summary of recommendations for serum allergy testingTests measuring immunoglobulin G (IgG) antibodies for diagnosis are not recommended.Screening panels of food allergens without previous consideration of the history is not recommended, because sensitization without clinical allergy is commonIntradermal tests are not recommended, because they are too sensitive and carry risk of a severe allergic reaction.Utilization1 year—7/1/16-6/30/17; paid claims only. 86005 had minimal billing (<$2000) during this periodClaim IndicatorSum of Allowed QuantityProcedure CodeSum of Billed QuantitySum of Allowed AmountSum of Billed AmountFFS/Managed Care Paid AmountCCOs840.0086001 –IGG12,318$3,867.92$82,460.25$15,287.14CCOs57,528.0086003 –IgE crude107,722$209,241.68$2,224,311.30$515,602.95FFS6.0086001 - IGG 23$29.97$911.66$29.97FFS3,767.0086003 – IgE Crude6,827$18,388.62$130,018.35$11397.02Major diagnoses paired with serum allergy testing in claims data review86001: R53.83 (other fatigue), Z13.0 (Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism), T78.40XA (Allergy, unspecified, initial encounter), K58 (Irritable bowel syndrome)86003: J30.9 (Allergic rhinitis, unspecified), L50.9 (Urticaria, unspecified), Z91.018 (Allergy to other foods), J45.909 (Unspecified asthma, uncomplicated), T78.40XA (Allergy, unspecified, initial encounter)HERC staff summary: Serum IgG testing is included in Choosing Wisely as a non-recommended test by the AAAAI and is not recommended by the AAP. Serum IgE testing appears to be useful when done in appropriate clinical settings for confirmation of allergies causing asthma, allergic rhinitis, and similar conditions, and for food allergies. Serum IgE testing is not appropriate when done as a screening panel and is listed as a non-recommended test in this setting in the AAAAI Choosing Wisely due to the high risk of non-clinically relevant positive results.HERC staff recommendations:Add specific serum IgE testing to the lines with allergic conditions that also contain skin allergen testing. Additionally, add to lines with food allergies. These tests should be used to confirm clinical suspicion of allergies, not for screening. They should be treated like the skin allergy testing CPT codes.Codes:86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each86008 Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, eachLines:9 ASTHMA124 ANAPHYLACTIC SHOCK; EDEMA OF LARYNX 223 OCCUPATIONAL LUNG DISEASES 313 DISORDERS INVOLVING THE IMMUNE SYSTEM530 ATOPIC DERMATITIS 531 CONTACT DERMATITIS AND OTHER ECZEMA 543 SYMPTOMATIC URTICARIA550 OTHER NONINFECTIOUS GASTROENTERITIS AND COLITIS 559 ALLERGIC RHINITIS AND CONJUNCTIVITIS, CHRONIC RHINITIS 566 DERMATITIS DUE TO SUBSTANCES TAKEN INTERNALLYAdvise HSD to remove 86003 from the Diagnostic Workup FileAdd 86001 Allergen specific IgG quantitative or semiquantitative, each allergen and 86006 Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card) to line 660 CONDITIONS FOR WHICH CERTAIN TREATMENTS HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS; unproven treatments with an entry for GN173 as shown belowAdvise HSD to remove 86001 and 86006 from the Diagnostic Work up FileGUIDELINE NOTE 173, TREATMENTS THAT HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS FOR CERTAIN CONDITIONS; unproven treatmentsThe following treatments are prioritized on Line 660, CONDITIONS FOR WHICH CERTAIN TREATMENTS HAVE NO CLINICALLY IMPORTANT BENEFIT OR HAVE HARMS THAT OUTWEIGH BENEFITS; unproven treatments for the conditions listed here:CPT/HCPCS codeINTERVENTIONRationaleDate of last Review86001Allergen specific IgG testingNo clinically important benefitNovember, 201786006Allergen specific IgE, multiallergen screenHarms outweigh benefitsNovember, 2017 ................
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