LCD Reference Article Billing and Coding Article

Billing and Coding: RAST Type Tests

A57043

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
CGS Administrators, LLC	MAC - Part A	15101 - MAC A	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part B	15102 - MAC B	J - 15	Kentucky
CGS Administrators, LLC	MAC - Part A	15201 - MAC A	J - 15	Ohio
CGS Administrators, LLC	MAC - Part B	15202 - MAC B	J - 15	Ohio

Article Information

General Information

Article ID
A57043

Article Title
Billing and Coding: RAST Type Tests

Article Type
Billing and Coding

Original Effective Date
09/12/2019

Revision Effective Date
08/08/2024

Revision Ending Date
N/A

Retirement Date
N/A

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act (SSA):

Section 1862 (a)(1)(A)allows coverage and payment for only those services considered medically reasonable and necessary.

Section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34063-RAST Type Tests.

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
Relevant medical history
Results of pertinent tests/procedures
Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.

For outpatient settings other than CORFs, references to "physicians" throughout this policy include non-physicians, such as nurse practitioners, clinical nurse specialists and physician assistants. Such non-physician practitioners, with certain exceptions, may certify, order and establish the plan of care as authorized by State law. (See Sections 1861[s][2] and 1862[a][14] of Title XVIII of the Social Security Act; 42 CFR, Sections 410.74, 410.75, 410.76 and 419.22; 58 FR 18543, April 7, 2000.)

CPT code 86003 will be covered only thirty (30) times in a year. Services exceeding this parameter will be considered not medically necessary.

CPT codes 86001 and 86005 are not covered services.

Other Comments:

For claims submitted to the Part A MAC: This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC. to process their claims.

Limitation of liability and refund requirements apply when denials are anticipated, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

Response To Comments

Number	Comment	Response
1

Coding Information

Bill Type Codes

Code	Description
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Revenue Codes

Code	Description
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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(355 Codes)

Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

The following ICD-10 Codes apply only to CPT code 86003:

Group 1 Codes

Code	Description
J30.0 - J30.2	Vasomotor rhinitis - Other seasonal allergic rhinitis
J30.5	Allergic rhinitis due to food
J30.81	Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89	Other allergic rhinitis
J30.9	Allergic rhinitis, unspecified
J45.20 - J45.22	Mild intermittent asthma, uncomplicated - Mild intermittent asthma with status asthmaticus
J45.30 - J45.32	Mild persistent asthma, uncomplicated - Mild persistent asthma with status asthmaticus
J45.40 - J45.42	Moderate persistent asthma, uncomplicated - Moderate persistent asthma with status asthmaticus
J45.50 - J45.52	Severe persistent asthma, uncomplicated - Severe persistent asthma with status asthmaticus
J45.901	Unspecified asthma with (acute) exacerbation
J45.902	Unspecified asthma with status asthmaticus
J45.909	Unspecified asthma, uncomplicated
J45.991	Cough variant asthma
J45.998	Other asthma
L20.0	Besnier's prurigo
L20.81	Atopic neurodermatitis
L20.82	Flexural eczema
L20.84	Intrinsic (allergic) eczema
L20.89	Other atopic dermatitis
L50.0	Allergic urticaria
L50.6	Contact urticaria
L50.8	Other urticaria
R06.2	Wheezing
T36.0X5A	Adverse effect of penicillins, initial encounter
T36.1X5A	Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.2X5A	Adverse effect of chloramphenicol group, initial encounter
T36.3X5A	Adverse effect of macrolides, initial encounter
T36.4X5A	Adverse effect of tetracyclines, initial encounter
T36.5X5A	Adverse effect of aminoglycosides, initial encounter
T36.6X5A	Adverse effect of rifampicins, initial encounter
T36.7X5A	Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.8X5A	Adverse effect of other systemic antibiotics, initial encounter
T37.0X5A	Adverse effect of sulfonamides, initial encounter
T37.1X5A	Adverse effect of antimycobacterial drugs, initial encounter
T37.2X5A	Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.3X5A	Adverse effect of other antiprotozoal drugs, initial encounter
T37.4X5A	Adverse effect of anthelminthics, initial encounter
T37.5X5A	Adverse effect of antiviral drugs, initial encounter
T37.8X5A	Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter
T38.0X5A	Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.1X5A	Adverse effect of thyroid hormones and substitutes, initial encounter
T38.2X5A	Adverse effect of antithyroid drugs, initial encounter
T38.4X5A	Adverse effect of oral contraceptives, initial encounter
T38.5X5A	Adverse effect of other estrogens and progestogens, initial encounter
T38.6X5A	Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.7X5A	Adverse effect of androgens and anabolic congeners, initial encounter
T38.815A	Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.895A	Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.995A	Adverse effect of other hormone antagonists, initial encounter
T39.015A	Adverse effect of aspirin, initial encounter
T39.095A	Adverse effect of salicylates, initial encounter
T39.1X5A	Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.2X5A	Adverse effect of pyrazolone derivatives, initial encounter
T39.315A	Adverse effect of propionic acid derivatives, initial encounter
T39.395A	Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.4X5A	Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.8X5A	Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T40.0X5A	Adverse effect of opium, initial encounter
T40.2X5A	Adverse effect of other opioids, initial encounter
T40.3X5A	Adverse effect of methadone, initial encounter
T40.495A	Adverse effect of other synthetic narcotics, initial encounter
T40.5X5A	Adverse effect of cocaine, initial encounter
T40.695A	Adverse effect of other narcotics, initial encounter
T40.715A	Adverse effect of cannabis, initial encounter
T40.725A	Adverse effect of synthetic cannabinoids, initial encounter
T40.995A	Adverse effect of other psychodysleptics [hallucinogens], initial encounter
T41.0X5A	Adverse effect of inhaled anesthetics, initial encounter
T41.1X5A	Adverse effect of intravenous anesthetics, initial encounter
T41.295A	Adverse effect of other general anesthetics, initial encounter
T41.3X5A	Adverse effect of local anesthetics, initial encounter
T41.5X5A	Adverse effect of therapeutic gases, initial encounter
T42.0X5A	Adverse effect of hydantoin derivatives, initial encounter
T42.1X5A	Adverse effect of iminostilbenes, initial encounter
T42.2X5A	Adverse effect of succinimides and oxazolidinediones, initial encounter
T42.3X5A	Adverse effect of barbiturates, initial encounter
T42.4X5A	Adverse effect of benzodiazepines, initial encounter
T42.5X5A	Adverse effect of mixed antiepileptics, initial encounter
T42.6X5A	Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter
T42.8X5A	Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter
T43.015A	Adverse effect of tricyclic antidepressants, initial encounter
T43.025A	Adverse effect of tetracyclic antidepressants, initial encounter
T43.1X5A	Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter
T43.215A	Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter
T43.225A	Adverse effect of selective serotonin reuptake inhibitors, initial encounter
T43.295A	Adverse effect of other antidepressants, initial encounter
T43.3X5A	Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter
T43.4X5A	Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter
T43.595A	Adverse effect of other antipsychotics and neuroleptics, initial encounter
T43.615A	Adverse effect of caffeine, initial encounter
T43.625A	Adverse effect of amphetamines, initial encounter
T43.635A	Adverse effect of methylphenidate, initial encounter
T43.651A	Poisoning by methamphetamines accidental (unintentional), initial encounter
T43.651D	Poisoning by methamphetamines accidental (unintentional), subsequent encounter
T43.651S	Poisoning by methamphetamines accidental (unintentional), sequela
T43.652A	Poisoning by methamphetamines intentional self-harm, initial encounter
T43.652D	Poisoning by methamphetamines intentional self-harm, subsequent encounter
T43.652S	Poisoning by methamphetamines intentional self-harm, sequela
T43.653A	Poisoning by methamphetamines, assault, initial encounter
T43.653D	Poisoning by methamphetamines, assault, subsequent encounter
T43.653S	Poisoning by methamphetamines, assault, sequela
T43.654A	Poisoning by methamphetamines, undetermined, initial encounter
T43.654D	Poisoning by methamphetamines, undetermined, subsequent encounter
T43.654S	Poisoning by methamphetamines, undetermined, sequela
T43.655A	Adverse effect of methamphetamines, initial encounter
T43.655D	Adverse effect of methamphetamines, subsequent encounter
T43.655S	Adverse effect of methamphetamines, sequela
T43.656A	Underdosing of methamphetamines, initial encounter
T43.656D	Underdosing of methamphetamines, subsequent encounter
T43.656S	Underdosing of methamphetamines, sequela
T43.695A	Adverse effect of other psychostimulants, initial encounter
T43.8X5A	Adverse effect of other psychotropic drugs, initial encounter
T44.0X5A	Adverse effect of anticholinesterase agents, initial encounter
T44.1X5A	Adverse effect of other parasympathomimetics [cholinergics], initial encounter
T44.2X5A	Adverse effect of ganglionic blocking drugs, initial encounter
T44.3X5A	Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.4X5A	Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.5X5A	Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.6X5A	Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.7X5A	Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.8X5A	Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.995A	Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T45.0X5A	Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.1X5A	Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.2X5A	Adverse effect of vitamins, initial encounter
T45.3X5A	Adverse effect of enzymes, initial encounter
T45.4X5A	Adverse effect of iron and its compounds, initial encounter
T45.515A	Adverse effect of anticoagulants, initial encounter
T45.525A	Adverse effect of antithrombotic drugs, initial encounter
T45.615A	Adverse effect of thrombolytic drugs, initial encounter
T45.625A	Adverse effect of hemostatic drug, initial encounter
T45.695A	Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.7X5A	Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.8X5A	Adverse effect of other primarily systemic and hematological agents, initial encounter
T46.0X5A	Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.1X5A	Adverse effect of calcium-channel blockers, initial encounter
T46.2X5A	Adverse effect of other antidysrhythmic drugs, initial encounter
T46.3X5A	Adverse effect of coronary vasodilators, initial encounter
T46.4X5A	Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.5X5A	Adverse effect of other antihypertensive drugs, initial encounter
T46.6X5A	Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.7X5A	Adverse effect of peripheral vasodilators, initial encounter
T46.8X5A	Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.995A	Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T47.0X5A	Adverse effect of histamine H2-receptor blockers, initial encounter
T47.1X5A	Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.2X5A	Adverse effect of stimulant laxatives, initial encounter
T47.3X5A	Adverse effect of saline and osmotic laxatives, initial encounter
T47.4X5A	Adverse effect of other laxatives, initial encounter
T47.5X5A	Adverse effect of digestants, initial encounter
T47.6X5A	Adverse effect of antidiarrheal drugs, initial encounter
T47.7X5A	Adverse effect of emetics, initial encounter
T47.8X5A	Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T48.0X5A	Adverse effect of oxytocic drugs, initial encounter
T48.1X5A	Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.295A	Adverse effect of other drugs acting on muscles, initial encounter
T48.3X5A	Adverse effect of antitussives, initial encounter
T48.4X5A	Adverse effect of expectorants, initial encounter
T48.5X5A	Adverse effect of other anti-common-cold drugs, initial encounter
T48.6X5A	Adverse effect of antiasthmatics, initial encounter
T48.995A	Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T49.0X5A	Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter
T49.1X5A	Adverse effect of antipruritics, initial encounter
T49.2X5A	Adverse effect of local astringents and local detergents, initial encounter
T49.3X5A	Adverse effect of emollients, demulcents and protectants, initial encounter
T49.4X5A	Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter
T49.5X5A	Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.6X5A	Adverse effect of otorhinolaryngological drugs and preparations, initial encounter
T49.7X5A	Adverse effect of dental drugs, topically applied, initial encounter
T49.8X5A	Adverse effect of other topical agents, initial encounter
T50.0X5A	Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.1X5A	Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.2X5A	Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.3X5A	Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.4X5A	Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.5X5A	Adverse effect of appetite depressants, initial encounter
T50.6X5A	Adverse effect of antidotes and chelating agents, initial encounter
T50.7X5A	Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.8X5A	Adverse effect of diagnostic agents, initial encounter
T50.A15A	Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A25A	Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A95A	Adverse effect of other bacterial vaccines, initial encounter
T50.B15A	Adverse effect of smallpox vaccines, initial encounter
T50.B95A	Adverse effect of other viral vaccines, initial encounter
T50.Z15A	Adverse effect of immunoglobulin, initial encounter
T50.Z95A	Adverse effect of other vaccines and biological substances, initial encounter
T50.905A	Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter
T50.995A	Adverse effect of other drugs, medicaments and biological substances, initial encounter
T63.011A*	Toxic effect of rattlesnake venom, accidental (unintentional), initial encounter
T63.012A*	Toxic effect of rattlesnake venom, intentional self-harm, initial encounter
T63.013A*	Toxic effect of rattlesnake venom, assault, initial encounter
T63.014A*	Toxic effect of rattlesnake venom, undetermined, initial encounter
T63.021A*	Toxic effect of coral snake venom, accidental (unintentional), initial encounter
T63.022A*	Toxic effect of coral snake venom, intentional self-harm, initial encounter
T63.023A*	Toxic effect of coral snake venom, assault, initial encounter
T63.024A*	Toxic effect of coral snake venom, undetermined, initial encounter
T63.031A*	Toxic effect of taipan venom, accidental (unintentional), initial encounter
T63.032A*	Toxic effect of taipan venom, intentional self-harm, initial encounter
T63.033A*	Toxic effect of taipan venom, assault, initial encounter
T63.034A*	Toxic effect of taipan venom, undetermined, initial encounter
T63.041A*	Toxic effect of cobra venom, accidental (unintentional), initial encounter
T63.042A*	Toxic effect of cobra venom, intentional self-harm, initial encounter
T63.043A*	Toxic effect of cobra venom, assault, initial encounter
T63.044A*	Toxic effect of cobra venom, undetermined, initial encounter
T63.061A*	Toxic effect of venom of other North and South American snake, accidental (unintentional), initial encounter
T63.062A*	Toxic effect of venom of other North and South American snake, intentional self-harm, initial encounter
T63.063A*	Toxic effect of venom of other North and South American snake, assault, initial encounter
T63.064A*	Toxic effect of venom of other North and South American snake, undetermined, initial encounter
T63.071A*	Toxic effect of venom of other Australian snake, accidental (unintentional), initial encounter
T63.072A*	Toxic effect of venom of other Australian snake, intentional self-harm, initial encounter
T63.073A*	Toxic effect of venom of other Australian snake, assault, initial encounter
T63.074A*	Toxic effect of venom of other Australian snake, undetermined, initial encounter
T63.081A*	Toxic effect of venom of other African and Asian snake, accidental (unintentional), initial encounter
T63.082A*	Toxic effect of venom of other African and Asian snake, intentional self-harm, initial encounter
T63.083A*	Toxic effect of venom of other African and Asian snake, assault, initial encounter
T63.084A*	Toxic effect of venom of other African and Asian snake, undetermined, initial encounter
T63.091A*	Toxic effect of venom of other snake, accidental (unintentional), initial encounter
T63.092A*	Toxic effect of venom of other snake, intentional self-harm, initial encounter
T63.093A*	Toxic effect of venom of other snake, assault, initial encounter
T63.094A*	Toxic effect of venom of other snake, undetermined, initial encounter
T63.111A*	Toxic effect of venom of gila monster, accidental (unintentional), initial encounter
T63.112A*	Toxic effect of venom of gila monster, intentional self-harm, initial encounter
T63.113A*	Toxic effect of venom of gila monster, assault, initial encounter
T63.114A*	Toxic effect of venom of gila monster, undetermined, initial encounter
T63.121A*	Toxic effect of venom of other venomous lizard, accidental (unintentional), initial encounter
T63.122A*	Toxic effect of venom of other venomous lizard, intentional self-harm, initial encounter
T63.123A*	Toxic effect of venom of other venomous lizard, assault, initial encounter
T63.124A*	Toxic effect of venom of other venomous lizard, undetermined, initial encounter
T63.191A*	Toxic effect of venom of other reptiles, accidental (unintentional), initial encounter
T63.192A*	Toxic effect of venom of other reptiles, intentional self-harm, initial encounter
T63.193A*	Toxic effect of venom of other reptiles, assault, initial encounter
T63.194A*	Toxic effect of venom of other reptiles, undetermined, initial encounter
T63.2X1A*	Toxic effect of venom of scorpion, accidental (unintentional), initial encounter
T63.2X2A	Toxic effect of venom of scorpion, intentional self-harm, initial encounter
T63.2X3A*	Toxic effect of venom of scorpion, assault, initial encounter
T63.2X4A*	Toxic effect of venom of scorpion, undetermined, initial encounter
T63.311A*	Toxic effect of venom of black widow spider, accidental (unintentional), initial encounter
T63.312A*	Toxic effect of venom of black widow spider, intentional self-harm, initial encounter
T63.313A*	Toxic effect of venom of black widow spider, assault, initial encounter
T63.314A*	Toxic effect of venom of black widow spider, undetermined, initial encounter
T63.321A*	Toxic effect of venom of tarantula, accidental (unintentional), initial encounter
T63.322A*	Toxic effect of venom of tarantula, intentional self-harm, initial encounter
T63.323A*	Toxic effect of venom of tarantula, assault, initial encounter
T63.324A*	Toxic effect of venom of tarantula, undetermined, initial encounter
T63.331A*	Toxic effect of venom of brown recluse spider, accidental (unintentional), initial encounter
T63.332A*	Toxic effect of venom of brown recluse spider, intentional self-harm, initial encounter
T63.333A*	Toxic effect of venom of brown recluse spider, assault, initial encounter
T63.334A*	Toxic effect of venom of brown recluse spider, undetermined, initial encounter
T63.391A*	Toxic effect of venom of other spider, accidental (unintentional), initial encounter
T63.392A*	Toxic effect of venom of other spider, intentional self-harm, initial encounter
T63.393A*	Toxic effect of venom of other spider, assault, initial encounter
T63.394A*	Toxic effect of venom of other spider, undetermined, initial encounter
T63.411A*	Toxic effect of venom of centipedes and venomous millipedes, accidental (unintentional), initial encounter
T63.412A*	Toxic effect of venom of centipedes and venomous millipedes, intentional self-harm, initial encounter
T63.413A*	Toxic effect of venom of centipedes and venomous millipedes, assault, initial encounter
T63.414A*	Toxic effect of venom of centipedes and venomous millipedes, undetermined, initial encounter
T63.421A*	Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.422A*	Toxic effect of venom of ants, intentional self-harm, initial encounter
T63.423A*	Toxic effect of venom of ants, assault, initial encounter
T63.424A*	Toxic effect of venom of ants, undetermined, initial encounter
T63.431A*	Toxic effect of venom of caterpillars, accidental (unintentional), initial encounter
T63.432A*	Toxic effect of venom of caterpillars, intentional self-harm, initial encounter
T63.433A*	Toxic effect of venom of caterpillars, assault, initial encounter
T63.434A*	Toxic effect of venom of caterpillars, undetermined, initial encounter
T63.441A*	Toxic effect of venom of bees, accidental (unintentional), initial encounter
T63.442A*	Toxic effect of venom of bees, intentional self-harm, initial encounter
T63.444A*	Toxic effect of venom of bees, undetermined, initial encounter
T63.451A*	Toxic effect of venom of hornets, accidental (unintentional), initial encounter
T63.452A*	Toxic effect of venom of hornets, intentional self-harm, initial encounter
T63.453A*	Toxic effect of venom of hornets, assault, initial encounter
T63.454A*	Toxic effect of venom of hornets, undetermined, initial encounter
T63.461A*	Toxic effect of venom of wasps, accidental (unintentional), initial encounter
T63.462A*	Toxic effect of venom of wasps, intentional self-harm, initial encounter
T63.463A*	Toxic effect of venom of wasps, assault, initial encounter
T63.464A*	Toxic effect of venom of wasps, undetermined, initial encounter
T63.481A*	Toxic effect of venom of other arthropod, accidental (unintentional), initial encounter
T63.482A*	Toxic effect of venom of other arthropod, intentional self-harm, initial encounter
T63.483A*	Toxic effect of venom of other arthropod, assault, initial encounter
T63.484A*	Toxic effect of venom of other arthropod, undetermined, initial encounter
T63.511A*	Toxic effect of contact with stingray, accidental (unintentional), initial encounter
T63.512A*	Toxic effect of contact with stingray, intentional self-harm, initial encounter
T63.513A*	Toxic effect of contact with stingray, assault, initial encounter
T63.514A*	Toxic effect of contact with stingray, undetermined, initial encounter
T63.591A*	Toxic effect of contact with other venomous fish, accidental (unintentional), initial encounter
T63.592A*	Toxic effect of contact with other venomous fish, intentional self-harm, initial encounter
T63.593A*	Toxic effect of contact with other venomous fish, assault, initial encounter
T63.594A*	Toxic effect of contact with other venomous fish, undetermined, initial encounter
T63.611A*	Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), initial encounter
T63.612A*	Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, initial encounter
T63.613A*	Toxic effect of contact with Portuguese Man-o-war, assault, initial encounter
T63.614A*	Toxic effect of contact with Portuguese Man-o-war, undetermined, initial encounter
T63.621A*	Toxic effect of contact with other jellyfish, accidental (unintentional), initial encounter
T63.622A*	Toxic effect of contact with other jellyfish, intentional self-harm, initial encounter
T63.623A*	Toxic effect of contact with other jellyfish, assault, initial encounter
T63.624A*	Toxic effect of contact with other jellyfish, undetermined, initial encounter
T63.631A*	Toxic effect of contact with sea anemone, accidental (unintentional), initial encounter
T63.632A*	Toxic effect of contact with sea anemone, intentional self-harm, initial encounter
T63.633A*	Toxic effect of contact with sea anemone, assault, initial encounter
T63.634A*	Toxic effect of contact with sea anemone, undetermined, initial encounter
T63.691A*	Toxic effect of contact with other venomous marine animals, accidental (unintentional), initial encounter
T63.692A*	Toxic effect of contact with other venomous marine animals, intentional self-harm, initial encounter
T63.693A*	Toxic effect of contact with other venomous marine animals, assault, initial encounter
T63.694A*	Toxic effect of contact with other venomous marine animals, undetermined, initial encounter
T63.711A*	Toxic effect of contact with venomous marine plant, accidental (unintentional), initial encounter
T63.712A*	Toxic effect of contact with venomous marine plant, intentional self-harm, initial encounter
T63.713A*	Toxic effect of contact with venomous marine plant, assault, initial encounter
T63.714A*	Toxic effect of contact with venomous marine plant, undetermined, initial encounter
T63.791A*	Toxic effect of contact with other venomous plant, accidental (unintentional), initial encounter
T63.792A*	Toxic effect of contact with other venomous plant, intentional self-harm, initial encounter
T63.793A*	Toxic effect of contact with other venomous plant, assault, initial encounter
T63.794A*	Toxic effect of contact with other venomous plant, undetermined, initial encounter
T63.811A*	Toxic effect of contact with venomous frog, accidental (unintentional), initial encounter
T63.812A*	Toxic effect of contact with venomous frog, intentional self-harm, initial encounter
T63.813A*	Toxic effect of contact with venomous frog, assault, initial encounter
T63.814A*	Toxic effect of contact with venomous frog, undetermined, initial encounter
T63.821A*	Toxic effect of contact with venomous toad, accidental (unintentional), initial encounter
T63.822A*	Toxic effect of contact with venomous toad, intentional self-harm, initial encounter
T63.823A*	Toxic effect of contact with venomous toad, assault, initial encounter
T63.824A*	Toxic effect of contact with venomous toad, undetermined, initial encounter
T63.831A*	Toxic effect of contact with other venomous amphibian, accidental (unintentional), initial encounter
T63.832A*	Toxic effect of contact with other venomous amphibian, intentional self-harm, initial encounter
T63.833A*	Toxic effect of contact with other venomous amphibian, assault, initial encounter
T63.834A*	Toxic effect of contact with other venomous amphibian, undetermined, initial encounter
T63.891A*	Toxic effect of contact with other venomous animals, accidental (unintentional), initial encounter
T63.892A*	Toxic effect of contact with other venomous animals, intentional self-harm, initial encounter
T63.893A*	Toxic effect of contact with other venomous animals, assault, initial encounter
T63.894A*	Toxic effect of contact with other venomous animals, undetermined, initial encounter
T78.00XA	Anaphylactic reaction due to unspecified food, initial encounter
T78.01XA	Anaphylactic reaction due to peanuts, initial encounter
T78.02XA	Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.03XA	Anaphylactic reaction due to other fish, initial encounter
T78.04XA	Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.05XA	Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.06XA	Anaphylactic reaction due to food additives, initial encounter
T78.07XA	Anaphylactic reaction due to milk and dairy products, initial encounter
T78.08XA	Anaphylactic reaction due to eggs, initial encounter
T78.09XA	Anaphylactic reaction due to other food products, initial encounter
T78.2XXA	Anaphylactic shock, unspecified, initial encounter
T78.3XXA	Angioneurotic edema, initial encounter
T78.40XA	Allergy, unspecified, initial encounter
T78.49XA	Other allergy, initial encounter
T88.59XA	Other complications of anesthesia, initial encounter
T88.6XXA	Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter
Z91.014	Allergy to mammalian meats
Z91.048	Other nonmedicinal substance allergy status
Z91.09	Other allergy status, other than to drugs and biological substances

Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*ICD-10-CM codes T63.011A-T63.2X4A should be reported for venom hypersensitivity.

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code	Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.

Code	Description
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Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
08/08/2024	R12	Revision Effective: 08/08/2024 Revision Explanation: Annual review, no changes.
11/16/2023	R11	Revision Effective: 11/16/2023 Revision Explanation: Updated LCD Reference Article section.
08/03/2023	R10	Revision Effective: 08/03/2023 Revision Explanation: Annual review, no changes.
10/01/2022	R9	Revision Effective: 10/01/2022 Revision Explanation: Annual ICD-10 Update, Added to Group 1 T43.651A, T43.651D, T43.651S, T43.652A, T43.652D, T43.652S, T43.653A, T43.653D, T43.653S, T43.654A, T43.654D, T43.654S, T43.655A, T43.655D, T43.655S, T43.656A, T43.656D, and T43.656S
08/04/2022	R8	Revision Effective: 08/04/2022 Revision Explanation: Annual review, no changes were made.
10/01/2021	R7	Revision Effective: 10/01/2021 Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 1 : Code T40.7X5A was removed and added T40.715A and T40.725A
10/01/2021	R6	Revision Effective: 10/01/2021 Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 1 : Code added Z91.014.
07/29/2021	R5	Revision Effective: 07/29/2021 Revision Explanation: Annual review, no changes were made.
10/01/2020	R4	Revision Effective: 10/01/2020 Revision Explanation: During annual ICD-10 review T40.4X5A was deleted and replaced with T40.495A.
12/05/2019	R3	Revision Effective: n/a Revision Explanation: Annual review, no changes made.
12/05/2019	R2	Revision Effective: 12/05/2019 Revision Explanation: Added other comments section in text and regulations to CMS National Policy section.
09/26/2019	R1	Revision Effective: 09/26/2019 Revision Explanation: Added additional Billing and Coding from associated information section from policy based on CR 10901.

Associated Documents

Related Local Coverage Documents
LCDs
L34063 - RAST Type Tests

Updated On	Effective Dates	Status
07/29/2024	08/08/2024 - N/A	Currently in Effect	You are here
11/10/2023	11/16/2023 - 08/07/2024	Superseded	View
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Billing and Coding: RAST Type Tests

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