Cigna policy for allergy billing

Coverage Policy for Allergy Testing -  Cigna

CIGNA covers the following in vivo allergy tests as medically necessary:

• prick/puncture and/or intradermal allergy testing to diagnose suspected immunoglobulin E (IgE) mediated hypersensitivity to inhalants, foods, hymenoptera (e.g., bee venom), drugs and/or chemicals

• skin patch testing to diagnose suspected contact allergic dermatitis

• photo patch testing to diagnose suspected contact photosensitization (e.g., photoallergic contact dermatitis)

• food/food additive ingestion double-blind challenge/provocation to diagnose suspected IgE-mediated hypersensitivity if skin testing is negative or equivocal, despite a history and physical findings suggestive of hypersensitivity

• drug provocation/bronchial challenge test to diagnose suspected IgE-mediated hypersensitivity when there is a confirmed history of allergy to a drug, and the individual requires the particular drug for treatment of a diagnosed condition, and there is no effective alternative drug available

• skin serial endpoint titration for determination of a safe starting dose for testing or immunotherapy when there is potential for the specific allergen in question to produce a severe systemic reaction or anaphylaxis (such as with bee venom)

CIGNA covers in vitro allergy testing (blood serum analysis, e.g., ImmunoCAP®, radioallergosorbent test [RAST], multiple radioallergosorbent test [MAST], fluorescent allergosorbent test [FAST], paper radioimmunosorbent test [PRIST], radioimmunosorbent test [RIST], enzyme-linked immunosorbenassay [ELISA], MRT [modified RAST], and VAST) as medically necessary when ANY of the following criteria is met:

• for the diagnosis of suspected IgE-mediated food or inhalant allergies for one of the following indications:

�� individuals with severe dermatographism, ichthyosis or generalized eczema
�� individuals who cannot be safely withdrawn from medications that interfere with skin testing (such as long-acting antihistamines, tricyclic antidepressants)
�� individuals who have a history of a previous systemic reaction to skin testing
�� individuals in whom skin testing was equivocal/inconclusive and in vitro testing is required as a confirmatory test
• as an alternative to skin testing for the evaluation of cross-reactivity between insect venoms
• when specific IgE immunoassays are used as adjunctive testing for disease activity of allergic bronchopulmonary aspergillosis and certain parasitic diseases

CIGNA does not cover in vitro allergy testing for ANY of the following, because it is considered not medically necessary:

• individuals with no contraindications to skin testing
• individuals being treated successfully for allergies
• individuals with mild symptoms
• individuals who have had negative skin testing for the allergy in question

CIGNA does not cover the following in vivo and in vitro allergy tests in the diagnosis or management of allergic disease because they are considered experimental/investigational or unproven (this list may not be all-inclusive):

• nasal challenge/provocation
• conjunctival challenge/provocation
• bronchial provocation/challenge testing for common allergens (e.g., dust, ragweed)
• provocation-neutralization testing (subcutaneous, sublingual or intradermal) or Rinkel test
• electrodermal testing or electro-acupuncture
• applied kinesiology or muscle strength testing of allergies
• reaginic pulse testing or pulse testing for allergies
• total serum IgE (except as noted in the General Background section of this coverage position)
• total serum immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM)
• testing of specific IgG antibody (e.g., by RAST or ELISA testing)
• cytotoxic testing, leukocytotoxic testing or Bryan’s test
• lymphocyte subset counts
• lymphocyte function assay
• cytokine and cytokine receptor assay
• food immune complex assay (FICA)
• leukocyte histamine release testing
• body chemical analysis
• antigen leukocyte cellular antibody (ALCAT) automated food allergy testing

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