Date Issued: 06/16/2021
Effective September 15, 2021, EmblemHealth has instituted a Medical Policy for Allergy Testing. According to New York State Medicaid Guidelines, CPT 86003 (Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each) has a frequency restriction of 30 units, in five years.
In addition, New York State Medicaid limits the following allergy testing codes to 40 units each, of the same code, in five years.
- 95024 - Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
- 95027 - Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts for airborne allergens, immediate type reaction, including test interpretation and report, specify number of tests
- 95028 - Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests
- 95044 - Patch or application test(s) (specify number of tests
Finally, New York State Medicaid limits the following allergy testing codes to 60 units each, of the same code, in five years.
- 95004 - Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests
- 95017 - Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with venoms, immediate type reaction, including test interpretation and report, specify number of tests
- 95018 - 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 tests
https://www.health.ny.gov/health_care/medicaid/program/update/2016/2016-05.htm#allergy