Allergen Specific IgE Testing Policy Updated

Effective for dates of service on or after October 1, 2017, when billing for CPT code 86003 (allergen specific IgE; quantitative or semiquantitative, each allergen) providers must include documentation in the recipient’s medical record with one of several newly established criteria. Claims billed with CPT code 86003 that do not have supporting medical documentation may result in recoupment. Services billed with CPT code 86003 may be reimbursable for 50 units per recipient, annually. Services exceeding this frequency will require a Treatment Authorization Request (TAR). Affected claims will be reprocessed via an Erroneous Payment Correction (EPC) for dates of service on or after October 1, 2017.