New allergy testing clinical edit goes into effect June 24

We value the care you provide our members and strive to reimburse you accurately and fairly for that care. Thoughtful implementation of clinical edits supports this goal, while allowing us to process your claims more efficiently.

On June 24, 2023, we’ll implement the new clinical edit outlined below:

IgE allergy testing

Products: Medicare | Provider type: Professional

Based on CMS policy, CPT code 86003 (Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each) shouldn’t exceed more than 30 units one year. This code will be denied when billed beyond 30 units in one year (a rolling 12-month period based on DOS).

See recent and upcoming Professional clinical edits