EmblemHealthMedical Policy for Allergy Testing
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 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 the 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 the 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 the number of tests
