Effective April 1, 2009, the documentation requirements for CPT-4 code 86003 (allergen specific IgE; quantitative or semiquantitative, each allergen) are updated below.
Providers must bill for radioallergosorbent testing using code 86003 and include documentation on the claim or on an attachment explaining why other allergy tests were not satisfactory. The claim must also include sufficient information to justify medical necessity for the allergy testing procedure, including at least one of the following:
- The skin tests were difficult to perform in a routine manner due to infancy, extensive eczema, dermographia or icthyasis.
- The skin test is inconclusive.
- Medications that interfere with skin testing (such as long-acting antihistamines or tricyclic antidepressants) cannot be safely discontinued.
- The patient has a history of systemic reaction to skin testing.
Without justification of medical necessity, claims billed with code 86003 may be denied.