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New Allergy Testing Policy

August 9, 2017

The Department of Health Care Services (DHCS) recently revised its allergy testing policy in response to stakeholder feedback and review of scientific literature. The revised blood allergy policy is based on a thorough review of various condition-specific clinical guidelines and feedback from the stakeholder communities, clinical professors and allergists.

Effective for dates of service on or after October 1, 2017, services billed with CPT-4 code 86003 (allergen specific IgE; quantitative or semiquantitative, each allergen) will be a benefit for up to 50 units per patient, annually. Services exceeding this frequency will require a Treatment Authorization Request (TAR). When submitting a claim, providers must document medical necessity in the patient’s medical record. Claims previously submitted for blood IgE tests up to 50 units per patient, annually, will be subject to an Erroneous Payment Correction (EPC).

Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for the release of a future Medi-Cal Update and the updated Allergy Testing and Desensitization section in the appropriate Part 2 manual, regarding the new policy.