LCD Reference Article Billing and Coding Article

Billing and Coding: Allergy Skin Testing

A56559

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
N/A
Article ID
A56559
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Allergy Skin Testing
Article Type
Billing and Coding
Original Effective Date
05/16/2019
Revision Effective Date
07/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §20.2 Physician Expense for Allergy Treatment

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Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Allergy Skin Testing L33417.

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(395 Codes)
Group 1 Paragraph

The CPT/HCPCS codes included in this article will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.

Medicare is establishing limited coverage for CPT/HCPCS codes 95004, 95017 and 95018.

 

Group 1 Codes
Code Description
H10.11 Acute atopic conjunctivitis, right eye
H10.12 Acute atopic conjunctivitis, left eye
H10.13 Acute atopic conjunctivitis, bilateral
H10.411 Chronic giant papillary conjunctivitis, right eye
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.44 Vernal conjunctivitis
H10.45 Other chronic allergic conjunctivitis
H16.261 Vernal keratoconjunctivitis, with limbar and corneal involvement, right eye
H16.262 Vernal keratoconjunctivitis, with limbar and corneal involvement, left eye
H16.263 Vernal keratoconjunctivitis, with limbar and corneal involvement, bilateral
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J31.0 Chronic rhinitis
J32.0 Chronic maxillary sinusitis
J32.1 Chronic frontal sinusitis
J32.2 Chronic ethmoidal sinusitis
J32.3 Chronic sphenoidal sinusitis
J32.4 Chronic pansinusitis
J32.8 Other chronic sinusitis
J32.9 Chronic sinusitis, unspecified
J33.0 Polyp of nasal cavity
J33.8 Other polyp of sinus
J34.3 Hypertrophy of nasal turbinates
J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.9 Chronic obstructive pulmonary disease, unspecified
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 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
J45.998 Other asthma
J82.83 Eosinophilic asthma
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L20.9 Atopic dermatitis, unspecified
L27.2 Dermatitis due to ingested food
L29.9 Pruritus, unspecified
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95D Adverse effect of other viral vaccines, subsequent encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.905D Adverse effect of unspecified drugs, medicaments and biological substances, subsequent encounter
T50.905S Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T63.001D Toxic effect of unspecified snake venom, accidental (unintentional), subsequent encounter
T63.001S Toxic effect of unspecified snake venom, accidental (unintentional), sequela
T63.002D Toxic effect of unspecified snake venom, intentional self-harm, subsequent encounter
T63.002S Toxic effect of unspecified snake venom, intentional self-harm, sequela
T63.003D Toxic effect of unspecified snake venom, assault, subsequent encounter
T63.003S Toxic effect of unspecified snake venom, assault, sequela
T63.004D Toxic effect of unspecified snake venom, undetermined, subsequent encounter
T63.004S Toxic effect of unspecified snake venom, undetermined, sequela
T63.011D Toxic effect of rattlesnake venom, accidental (unintentional), subsequent encounter
T63.011S Toxic effect of rattlesnake venom, accidental (unintentional), sequela
T63.012D Toxic effect of rattlesnake venom, intentional self-harm, subsequent encounter
T63.012S Toxic effect of rattlesnake venom, intentional self-harm, sequela
T63.013D Toxic effect of rattlesnake venom, assault, subsequent encounter
T63.013S Toxic effect of rattlesnake venom, assault, sequela
T63.014D Toxic effect of rattlesnake venom, undetermined, subsequent encounter
T63.014S Toxic effect of rattlesnake venom, undetermined, sequela
T63.021D Toxic effect of coral snake venom, accidental (unintentional), subsequent encounter
T63.021S Toxic effect of coral snake venom, accidental (unintentional), sequela
T63.022D Toxic effect of coral snake venom, intentional self-harm, subsequent encounter
T63.022S Toxic effect of coral snake venom, intentional self-harm, sequela
T63.023D Toxic effect of coral snake venom, assault, subsequent encounter
T63.023S Toxic effect of coral snake venom, assault, sequela
T63.024D Toxic effect of coral snake venom, undetermined, subsequent encounter
T63.024S Toxic effect of coral snake venom, undetermined, sequela
T63.031D Toxic effect of taipan venom, accidental (unintentional), subsequent encounter
T63.031S Toxic effect of taipan venom, accidental (unintentional), sequela
T63.032D Toxic effect of taipan venom, intentional self-harm, subsequent encounter
T63.032S Toxic effect of taipan venom, intentional self-harm, sequela
T63.033D Toxic effect of taipan venom, assault, subsequent encounter
T63.033S Toxic effect of taipan venom, assault, sequela
T63.034D Toxic effect of taipan venom, undetermined, subsequent encounter
T63.034S Toxic effect of taipan venom, undetermined, sequela
T63.041D Toxic effect of cobra venom, accidental (unintentional), subsequent encounter
T63.041S Toxic effect of cobra venom, accidental (unintentional), sequela
T63.042D Toxic effect of cobra venom, intentional self-harm, subsequent encounter
T63.042S Toxic effect of cobra venom, intentional self-harm, sequela
T63.043D Toxic effect of cobra venom, assault, subsequent encounter
T63.043S Toxic effect of cobra venom, assault, sequela
T63.044D Toxic effect of cobra venom, undetermined, subsequent encounter
T63.044S Toxic effect of cobra venom, undetermined, sequela
T63.061D Toxic effect of venom of other North and South American snake, accidental (unintentional), subsequent encounter
T63.061S Toxic effect of venom of other North and South American snake, accidental (unintentional), sequela
T63.062D Toxic effect of venom of other North and South American snake, intentional self-harm, subsequent encounter
T63.062S Toxic effect of venom of other North and South American snake, intentional self-harm, sequela
T63.063D Toxic effect of venom of other North and South American snake, assault, subsequent encounter
T63.063S Toxic effect of venom of other North and South American snake, assault, sequela
T63.064D Toxic effect of venom of other North and South American snake, undetermined, subsequent encounter
T63.064S Toxic effect of venom of other North and South American snake, undetermined, sequela
T63.071D Toxic effect of venom of other Australian snake, accidental (unintentional), subsequent encounter
T63.071S Toxic effect of venom of other Australian snake, accidental (unintentional), sequela
T63.072D Toxic effect of venom of other Australian snake, intentional self-harm, subsequent encounter
T63.072S Toxic effect of venom of other Australian snake, intentional self-harm, sequela
T63.073D Toxic effect of venom of other Australian snake, assault, subsequent encounter
T63.073S Toxic effect of venom of other Australian snake, assault, sequela
T63.074D Toxic effect of venom of other Australian snake, undetermined, subsequent encounter
T63.074S Toxic effect of venom of other Australian snake, undetermined, sequela
T63.081D Toxic effect of venom of other African and Asian snake, accidental (unintentional), subsequent encounter
T63.081S Toxic effect of venom of other African and Asian snake, accidental (unintentional), sequela
T63.082D Toxic effect of venom of other African and Asian snake, intentional self-harm, subsequent encounter
T63.082S Toxic effect of venom of other African and Asian snake, intentional self-harm, sequela
T63.083D Toxic effect of venom of other African and Asian snake, assault, subsequent encounter
T63.083S Toxic effect of venom of other African and Asian snake, assault, sequela
T63.084D Toxic effect of venom of other African and Asian snake, undetermined, subsequent encounter
T63.084S Toxic effect of venom of other African and Asian snake, undetermined, sequela
T63.091D Toxic effect of venom of other snake, accidental (unintentional), subsequent encounter
T63.091S Toxic effect of venom of other snake, accidental (unintentional), sequela
T63.092D Toxic effect of venom of other snake, intentional self-harm, subsequent encounter
T63.092S Toxic effect of venom of other snake, intentional self-harm, sequela
T63.093D Toxic effect of venom of other snake, assault, subsequent encounter
T63.093S Toxic effect of venom of other snake, assault, sequela
T63.094D Toxic effect of venom of other snake, undetermined, subsequent encounter
T63.094S Toxic effect of venom of other snake, undetermined, sequela
T63.111D Toxic effect of venom of gila monster, accidental (unintentional), subsequent encounter
T63.111S Toxic effect of venom of gila monster, accidental (unintentional), sequela
T63.112D Toxic effect of venom of gila monster, intentional self-harm, subsequent encounter
T63.112S Toxic effect of venom of gila monster, intentional self-harm, sequela
T63.113D Toxic effect of venom of gila monster, assault, subsequent encounter
T63.113S Toxic effect of venom of gila monster, assault, sequela
T63.114D Toxic effect of venom of gila monster, undetermined, subsequent encounter
T63.114S Toxic effect of venom of gila monster, undetermined, sequela
T63.121D Toxic effect of venom of other venomous lizard, accidental (unintentional), subsequent encounter
T63.121S Toxic effect of venom of other venomous lizard, accidental (unintentional), sequela
T63.122D Toxic effect of venom of other venomous lizard, intentional self-harm, subsequent encounter
T63.122S Toxic effect of venom of other venomous lizard, intentional self-harm, sequela
T63.123D Toxic effect of venom of other venomous lizard, assault, subsequent encounter
T63.123S Toxic effect of venom of other venomous lizard, assault, sequela
T63.124D Toxic effect of venom of other venomous lizard, undetermined, subsequent encounter
T63.124S Toxic effect of venom of other venomous lizard, undetermined, sequela
T63.191D Toxic effect of venom of other reptiles, accidental (unintentional), subsequent encounter
T63.191S Toxic effect of venom of other reptiles, accidental (unintentional), sequela
T63.192D Toxic effect of venom of other reptiles, intentional self-harm, subsequent encounter
T63.192S Toxic effect of venom of other reptiles, intentional self-harm, sequela
T63.193D Toxic effect of venom of other reptiles, assault, subsequent encounter
T63.193S Toxic effect of venom of other reptiles, assault, sequela
T63.194D Toxic effect of venom of other reptiles, undetermined, subsequent encounter
T63.194S Toxic effect of venom of other reptiles, undetermined, sequela
T63.2X1D Toxic effect of venom of scorpion, accidental (unintentional), subsequent encounter
T63.2X1S Toxic effect of venom of scorpion, accidental (unintentional), sequela
T63.2X2D Toxic effect of venom of scorpion, intentional self-harm, subsequent encounter
T63.2X2S Toxic effect of venom of scorpion, intentional self-harm, sequela
T63.2X3D Toxic effect of venom of scorpion, assault, subsequent encounter
T63.2X3S Toxic effect of venom of scorpion, assault, sequela
T63.2X4D Toxic effect of venom of scorpion, undetermined, subsequent encounter
T63.2X4S Toxic effect of venom of scorpion, undetermined, sequela
T63.301D Toxic effect of unspecified spider venom, accidental (unintentional), subsequent encounter
T63.301S Toxic effect of unspecified spider venom, accidental (unintentional), sequela
T63.302D Toxic effect of unspecified spider venom, intentional self-harm, subsequent encounter
T63.302S Toxic effect of unspecified spider venom, intentional self-harm, sequela
T63.303D Toxic effect of unspecified spider venom, assault, subsequent encounter
T63.303S Toxic effect of unspecified spider venom, assault, sequela
T63.304D Toxic effect of unspecified spider venom, undetermined, subsequent encounter
T63.304S Toxic effect of unspecified spider venom, undetermined, sequela
T63.311D Toxic effect of venom of black widow spider, accidental (unintentional), subsequent encounter
T63.311S Toxic effect of venom of black widow spider, accidental (unintentional), sequela
T63.312D Toxic effect of venom of black widow spider, intentional self-harm, subsequent encounter
T63.312S Toxic effect of venom of black widow spider, intentional self-harm, sequela
T63.313D Toxic effect of venom of black widow spider, assault, subsequent encounter
T63.313S Toxic effect of venom of black widow spider, assault, sequela
T63.314D Toxic effect of venom of black widow spider, undetermined, subsequent encounter
T63.314S Toxic effect of venom of black widow spider, undetermined, sequela
T63.321D Toxic effect of venom of tarantula, accidental (unintentional), subsequent encounter
T63.321S Toxic effect of venom of tarantula, accidental (unintentional), sequela
T63.322D Toxic effect of venom of tarantula, intentional self-harm, subsequent encounter
T63.322S Toxic effect of venom of tarantula, intentional self-harm, sequela
T63.323D Toxic effect of venom of tarantula, assault, subsequent encounter
T63.323S Toxic effect of venom of tarantula, assault, sequela
T63.324D Toxic effect of venom of tarantula, undetermined, subsequent encounter
T63.324S Toxic effect of venom of tarantula, undetermined, sequela
T63.331D Toxic effect of venom of brown recluse spider, accidental (unintentional), subsequent encounter
T63.331S Toxic effect of venom of brown recluse spider, accidental (unintentional), sequela
T63.332D Toxic effect of venom of brown recluse spider, intentional self-harm, subsequent encounter
T63.332S Toxic effect of venom of brown recluse spider, intentional self-harm, sequela
T63.333D Toxic effect of venom of brown recluse spider, assault, subsequent encounter
T63.333S Toxic effect of venom of brown recluse spider, assault, sequela
T63.334D Toxic effect of venom of brown recluse spider, undetermined, subsequent encounter
T63.334S Toxic effect of venom of brown recluse spider, undetermined, sequela
T63.391D Toxic effect of venom of other spider, accidental (unintentional), subsequent encounter
T63.391S Toxic effect of venom of other spider, accidental (unintentional), sequela
T63.392D Toxic effect of venom of other spider, intentional self-harm, subsequent encounter
T63.392S Toxic effect of venom of other spider, intentional self-harm, sequela
T63.393D Toxic effect of venom of other spider, assault, subsequent encounter
T63.393S Toxic effect of venom of other spider, assault, sequela
T63.394D Toxic effect of venom of other spider, undetermined, subsequent encounter
T63.394S Toxic effect of venom of other spider, undetermined, sequela
T63.411D Toxic effect of venom of centipedes and venomous millipedes, accidental (unintentional), subsequent encounter
T63.411S Toxic effect of venom of centipedes and venomous millipedes, accidental (unintentional), sequela
T63.412D Toxic effect of venom of centipedes and venomous millipedes, intentional self-harm, subsequent encounter
T63.412S Toxic effect of venom of centipedes and venomous millipedes, intentional self-harm, sequela
T63.413D Toxic effect of venom of centipedes and venomous millipedes, assault, subsequent encounter
T63.413S Toxic effect of venom of centipedes and venomous millipedes, assault, sequela
T63.414D Toxic effect of venom of centipedes and venomous millipedes, undetermined, subsequent encounter
T63.414S Toxic effect of venom of centipedes and venomous millipedes, undetermined, sequela
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.421S Toxic effect of venom of ants, accidental (unintentional), sequela
T63.422D Toxic effect of venom of ants, intentional self-harm, subsequent encounter
T63.422S Toxic effect of venom of ants, intentional self-harm, sequela
T63.423D Toxic effect of venom of ants, assault, subsequent encounter
T63.423S Toxic effect of venom of ants, assault, sequela
T63.424D Toxic effect of venom of ants, undetermined, subsequent encounter
T63.424S Toxic effect of venom of ants, undetermined, sequela
T63.431D Toxic effect of venom of caterpillars, accidental (unintentional), subsequent encounter
T63.431S Toxic effect of venom of caterpillars, accidental (unintentional), sequela
T63.432D Toxic effect of venom of caterpillars, intentional self-harm, subsequent encounter
T63.432S Toxic effect of venom of caterpillars, intentional self-harm, sequela
T63.433D Toxic effect of venom of caterpillars, assault, subsequent encounter
T63.433S Toxic effect of venom of caterpillars, assault, sequela
T63.434D Toxic effect of venom of caterpillars, undetermined, subsequent encounter
T63.434S Toxic effect of venom of caterpillars, undetermined, sequela
T63.441D Toxic effect of venom of bees, accidental (unintentional), subsequent encounter
T63.441S Toxic effect of venom of bees, accidental (unintentional), sequela
T63.442D Toxic effect of venom of bees, intentional self-harm, subsequent encounter
T63.442S Toxic effect of venom of bees, intentional self-harm, sequela
T63.443D Toxic effect of venom of bees, assault, subsequent encounter
T63.443S Toxic effect of venom of bees, assault, sequela
T63.444D Toxic effect of venom of bees, undetermined, subsequent encounter
T63.444S Toxic effect of venom of bees, undetermined, sequela
T63.451D Toxic effect of venom of hornets, accidental (unintentional), subsequent encounter
T63.451S Toxic effect of venom of hornets, accidental (unintentional), sequela
T63.452D Toxic effect of venom of hornets, intentional self-harm, subsequent encounter
T63.452S Toxic effect of venom of hornets, intentional self-harm, sequela
T63.453D Toxic effect of venom of hornets, assault, subsequent encounter
T63.453S Toxic effect of venom of hornets, assault, sequela
T63.454D Toxic effect of venom of hornets, undetermined, subsequent encounter
T63.454S Toxic effect of venom of hornets, undetermined, sequela
T63.461D Toxic effect of venom of wasps, accidental (unintentional), subsequent encounter
T63.461S Toxic effect of venom of wasps, accidental (unintentional), sequela
T63.462D Toxic effect of venom of wasps, intentional self-harm, subsequent encounter
T63.462S Toxic effect of venom of wasps, intentional self-harm, sequela
T63.463D Toxic effect of venom of wasps, assault, subsequent encounter
T63.463S Toxic effect of venom of wasps, assault, sequela
T63.464D Toxic effect of venom of wasps, undetermined, subsequent encounter
T63.464S Toxic effect of venom of wasps, undetermined, sequela
T63.481D Toxic effect of venom of other arthropod, accidental (unintentional), subsequent encounter
T63.481S Toxic effect of venom of other arthropod, accidental (unintentional), sequela
T63.482D Toxic effect of venom of other arthropod, intentional self-harm, subsequent encounter
T63.482S Toxic effect of venom of other arthropod, intentional self-harm, sequela
T63.483D Toxic effect of venom of other arthropod, assault, subsequent encounter
T63.483S Toxic effect of venom of other arthropod, assault, sequela
T63.484D Toxic effect of venom of other arthropod, undetermined, subsequent encounter
T63.484S Toxic effect of venom of other arthropod, undetermined, sequela
T63.511D Toxic effect of contact with stingray, accidental (unintentional), subsequent encounter
T63.511S Toxic effect of contact with stingray, accidental (unintentional), sequela
T63.512D Toxic effect of contact with stingray, intentional self-harm, subsequent encounter
T63.512S Toxic effect of contact with stingray, intentional self-harm, sequela
T63.513D Toxic effect of contact with stingray, assault, subsequent encounter
T63.513S Toxic effect of contact with stingray, assault, sequela
T63.514D Toxic effect of contact with stingray, undetermined, subsequent encounter
T63.514S Toxic effect of contact with stingray, undetermined, sequela
T63.591D Toxic effect of contact with other venomous fish, accidental (unintentional), subsequent encounter
T63.591S Toxic effect of contact with other venomous fish, accidental (unintentional), sequela
T63.592D Toxic effect of contact with other venomous fish, intentional self-harm, subsequent encounter
T63.592S Toxic effect of contact with other venomous fish, intentional self-harm, sequela
T63.593D Toxic effect of contact with other venomous fish, assault, subsequent encounter
T63.593S Toxic effect of contact with other venomous fish, assault, sequela
T63.594D Toxic effect of contact with other venomous fish, undetermined, subsequent encounter
T63.594S Toxic effect of contact with other venomous fish, undetermined, sequela
T63.611D Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), subsequent encounter
T63.611S Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), sequela
T63.612D Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, subsequent encounter
T63.612S Toxic effect of contact with Portuguese Man-o-war, intentional self-harm, sequela
T63.613D Toxic effect of contact with Portuguese Man-o-war, assault, subsequent encounter
T63.613S Toxic effect of contact with Portuguese Man-o-war, assault, sequela
T63.614D Toxic effect of contact with Portuguese Man-o-war, undetermined, subsequent encounter
T63.614S Toxic effect of contact with Portuguese Man-o-war, undetermined, sequela
T63.621D Toxic effect of contact with other jellyfish, accidental (unintentional), subsequent encounter
T63.621S Toxic effect of contact with other jellyfish, accidental (unintentional), sequela
T63.622D Toxic effect of contact with other jellyfish, intentional self-harm, subsequent encounter
T63.622S Toxic effect of contact with other jellyfish, intentional self-harm, sequela
T63.623D Toxic effect of contact with other jellyfish, assault, subsequent encounter
T63.623S Toxic effect of contact with other jellyfish, assault, sequela
T63.624D Toxic effect of contact with other jellyfish, undetermined, subsequent encounter
T63.624S Toxic effect of contact with other jellyfish, undetermined, sequela
T63.631D Toxic effect of contact with sea anemone, accidental (unintentional), subsequent encounter
T63.631S Toxic effect of contact with sea anemone, accidental (unintentional), sequela
T63.632D Toxic effect of contact with sea anemone, intentional self-harm, subsequent encounter
T63.632S Toxic effect of contact with sea anemone, intentional self-harm, sequela
T63.633D Toxic effect of contact with sea anemone, assault, subsequent encounter
T63.633S Toxic effect of contact with sea anemone, assault, sequela
T63.634D Toxic effect of contact with sea anemone, undetermined, subsequent encounter
T63.634S Toxic effect of contact with sea anemone, undetermined, sequela
T63.691D Toxic effect of contact with other venomous marine animals, accidental (unintentional), subsequent encounter
T63.691S Toxic effect of contact with other venomous marine animals, accidental (unintentional), sequela
T63.692D Toxic effect of contact with other venomous marine animals, intentional self-harm, subsequent encounter
T63.692S Toxic effect of contact with other venomous marine animals, intentional self-harm, sequela
T63.693D Toxic effect of contact with other venomous marine animals, assault, subsequent encounter
T63.693S Toxic effect of contact with other venomous marine animals, assault, sequela
T63.694D Toxic effect of contact with other venomous marine animals, undetermined, subsequent encounter
T63.694S Toxic effect of contact with other venomous marine animals, undetermined, sequela
T63.711D Toxic effect of contact with venomous marine plant, accidental (unintentional), subsequent encounter
T63.711S Toxic effect of contact with venomous marine plant, accidental (unintentional), sequela
T63.712D Toxic effect of contact with venomous marine plant, intentional self-harm, subsequent encounter
T63.712S Toxic effect of contact with venomous marine plant, intentional self-harm, sequela
T63.713D Toxic effect of contact with venomous marine plant, assault, subsequent encounter
T63.713S Toxic effect of contact with venomous marine plant, assault, sequela
T63.714D Toxic effect of contact with venomous marine plant, undetermined, subsequent encounter
T63.714S Toxic effect of contact with venomous marine plant, undetermined, sequela
T63.791D Toxic effect of contact with other venomous plant, accidental (unintentional), subsequent encounter
T63.791S Toxic effect of contact with other venomous plant, accidental (unintentional), sequela
T63.792D Toxic effect of contact with other venomous plant, intentional self-harm, subsequent encounter
T63.792S Toxic effect of contact with other venomous plant, intentional self-harm, sequela
T63.793D Toxic effect of contact with other venomous plant, assault, subsequent encounter
T63.793S Toxic effect of contact with other venomous plant, assault, sequela
T63.794D Toxic effect of contact with other venomous plant, undetermined, subsequent encounter
T63.794S Toxic effect of contact with other venomous plant, undetermined, sequela
T63.811D Toxic effect of contact with venomous frog, accidental (unintentional), subsequent encounter
T63.811S Toxic effect of contact with venomous frog, accidental (unintentional), sequela
T63.812D Toxic effect of contact with venomous frog, intentional self-harm, subsequent encounter
T63.812S Toxic effect of contact with venomous frog, intentional self-harm, sequela
T63.813D Toxic effect of contact with venomous frog, assault, subsequent encounter
T63.813S Toxic effect of contact with venomous frog, assault, sequela
T63.814D Toxic effect of contact with venomous frog, undetermined, subsequent encounter
T63.814S Toxic effect of contact with venomous frog, undetermined, sequela
T63.821D Toxic effect of contact with venomous toad, accidental (unintentional), subsequent encounter
T63.821S Toxic effect of contact with venomous toad, accidental (unintentional), sequela
T63.822D Toxic effect of contact with venomous toad, intentional self-harm, subsequent encounter
T63.822S Toxic effect of contact with venomous toad, intentional self-harm, sequela
T63.823D Toxic effect of contact with venomous toad, assault, subsequent encounter
T63.823S Toxic effect of contact with venomous toad, assault, sequela
T63.824D Toxic effect of contact with venomous toad, undetermined, subsequent encounter
T63.824S Toxic effect of contact with venomous toad, undetermined, sequela
T63.831D Toxic effect of contact with other venomous amphibian, accidental (unintentional), subsequent encounter
T63.831S Toxic effect of contact with other venomous amphibian, accidental (unintentional), sequela
T63.832D Toxic effect of contact with other venomous amphibian, intentional self-harm, subsequent encounter
T63.832S Toxic effect of contact with other venomous amphibian, intentional self-harm, sequela
T63.833D Toxic effect of contact with other venomous amphibian, assault, subsequent encounter
T63.833S Toxic effect of contact with other venomous amphibian, assault, sequela
T63.834D Toxic effect of contact with other venomous amphibian, undetermined, subsequent encounter
T63.834S Toxic effect of contact with other venomous amphibian, undetermined, sequela
T63.891D Toxic effect of contact with other venomous animals, accidental (unintentional), subsequent encounter
T63.891S Toxic effect of contact with other venomous animals, accidental (unintentional), sequela
T63.892D Toxic effect of contact with other venomous animals, intentional self-harm, subsequent encounter
T63.892S Toxic effect of contact with other venomous animals, intentional self-harm, sequela
T63.893D Toxic effect of contact with other venomous animals, assault, subsequent encounter
T63.893S Toxic effect of contact with other venomous animals, assault, sequela
T63.894D Toxic effect of contact with other venomous animals, undetermined, subsequent encounter
T63.894S Toxic effect of contact with other venomous animals, undetermined, sequela
T78.00XD Anaphylactic reaction due to unspecified food, subsequent encounter
T78.00XS Anaphylactic reaction due to unspecified food, sequela
T78.01XD Anaphylactic reaction due to peanuts, subsequent encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XD Anaphylactic reaction due to shellfish (crustaceans), subsequent encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XD Anaphylactic reaction due to other fish, subsequent encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XD Anaphylactic reaction due to fruits and vegetables, subsequent encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XD Anaphylactic reaction due to tree nuts and seeds, subsequent encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XD Anaphylactic reaction due to food additives, subsequent encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XD Anaphylactic reaction due to milk and dairy products, subsequent encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XD Anaphylactic reaction due to eggs, subsequent encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XD Anaphylactic reaction due to other food products, subsequent encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.1XXD Other adverse food reactions, not elsewhere classified, subsequent encounter
T78.1XXS Other adverse food reactions, not elsewhere classified, sequela
T78.2XXD Anaphylactic shock, unspecified, subsequent encounter
T78.2XXS Anaphylactic shock, unspecified, sequela
T78.3XXD Angioneurotic edema, subsequent encounter
T78.3XXS Angioneurotic edema, sequela
T88.1XXA Other complications following immunization, not elsewhere classified, initial encounter
T88.1XXD Other complications following immunization, not elsewhere classified, subsequent encounter
T88.1XXS Other complications following immunization, not elsewhere classified, sequela
T88.6XXD Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela
Z51.6* Encounter for desensitization to allergens
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Note: Z51.6* should not be billed as a primary diagnosis code on the claim.

Group 2

(206 Codes)
Group 2 Paragraph

Medicare is establishing limited coverage for CPT/HCPCS code 95024.

 

Group 2 Codes
Code Description
H10.11 Acute atopic conjunctivitis, right eye
H10.12 Acute atopic conjunctivitis, left eye
H10.13 Acute atopic conjunctivitis, bilateral
H10.411 Chronic giant papillary conjunctivitis, right eye
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.419 Chronic giant papillary conjunctivitis, unspecified eye
H10.44 Vernal conjunctivitis
H10.45 Other chronic allergic conjunctivitis
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J31.0 Chronic rhinitis
J32.0 Chronic maxillary sinusitis
J32.1 Chronic frontal sinusitis
J32.2 Chronic ethmoidal sinusitis
J32.3 Chronic sphenoidal sinusitis
J32.4 Chronic pansinusitis
J32.8 Other chronic sinusitis
J32.9 Chronic sinusitis, unspecified
J33.0 Polyp of nasal cavity
J33.8 Other polyp of sinus
J34.3 Hypertrophy of nasal turbinates
J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection
J44.1 Chronic obstructive pulmonary disease with (acute) exacerbation
J44.81 Bronchiolitis obliterans and bronchiolitis obliterans syndrome
J44.89 Other specified chronic obstructive pulmonary disease
J44.9 Chronic obstructive pulmonary disease, unspecified
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 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
J45.998 Other asthma
J82.83 Eosinophilic asthma
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L20.9 Atopic dermatitis, unspecified
L29.9 Pruritus, unspecified
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T63.001D Toxic effect of unspecified snake venom, accidental (unintentional), subsequent encounter
T63.001S Toxic effect of unspecified snake venom, accidental (unintentional), sequela
T63.002D Toxic effect of unspecified snake venom, intentional self-harm, subsequent encounter
T63.002S Toxic effect of unspecified snake venom, intentional self-harm, sequela
T63.003D Toxic effect of unspecified snake venom, assault, subsequent encounter
T63.003S Toxic effect of unspecified snake venom, assault, sequela
T63.004D Toxic effect of unspecified snake venom, undetermined, subsequent encounter
T63.004S Toxic effect of unspecified snake venom, undetermined, sequela
T63.011D Toxic effect of rattlesnake venom, accidental (unintentional), subsequent encounter
T63.011S Toxic effect of rattlesnake venom, accidental (unintentional), sequela
T63.012D Toxic effect of rattlesnake venom, intentional self-harm, subsequent encounter
T63.012S Toxic effect of rattlesnake venom, intentional self-harm, sequela
T63.013D Toxic effect of rattlesnake venom, assault, subsequent encounter
T63.013S Toxic effect of rattlesnake venom, assault, sequela
T63.014D Toxic effect of rattlesnake venom, undetermined, subsequent encounter
T63.014S Toxic effect of rattlesnake venom, undetermined, sequela
T63.021D Toxic effect of coral snake venom, accidental (unintentional), subsequent encounter
T63.021S Toxic effect of coral snake venom, accidental (unintentional), sequela
T63.022D Toxic effect of coral snake venom, intentional self-harm, subsequent encounter
T63.022S Toxic effect of coral snake venom, intentional self-harm, sequela
T63.023D Toxic effect of coral snake venom, assault, subsequent encounter
T63.023S Toxic effect of coral snake venom, assault, sequela
T63.024D Toxic effect of coral snake venom, undetermined, subsequent encounter
T63.024S Toxic effect of coral snake venom, undetermined, sequela
T63.031D Toxic effect of taipan venom, accidental (unintentional), subsequent encounter
T63.031S Toxic effect of taipan venom, accidental (unintentional), sequela
T63.032D Toxic effect of taipan venom, intentional self-harm, subsequent encounter
T63.032S Toxic effect of taipan venom, intentional self-harm, sequela
T63.033D Toxic effect of taipan venom, assault, subsequent encounter
T63.033S Toxic effect of taipan venom, assault, sequela
T63.034D Toxic effect of taipan venom, undetermined, subsequent encounter
T63.034S Toxic effect of taipan venom, undetermined, sequela
T63.041D Toxic effect of cobra venom, accidental (unintentional), subsequent encounter
T63.041S Toxic effect of cobra venom, accidental (unintentional), sequela
T63.042D Toxic effect of cobra venom, intentional self-harm, subsequent encounter
T63.042S Toxic effect of cobra venom, intentional self-harm, sequela
T63.043D Toxic effect of cobra venom, assault, subsequent encounter
T63.043S Toxic effect of cobra venom, assault, sequela
T63.044D Toxic effect of cobra venom, undetermined, subsequent encounter
T63.044S Toxic effect of cobra venom, undetermined, sequela
T63.061D Toxic effect of venom of other North and South American snake, accidental (unintentional), subsequent encounter
T63.061S Toxic effect of venom of other North and South American snake, accidental (unintentional), sequela
T63.062D Toxic effect of venom of other North and South American snake, intentional self-harm, subsequent encounter
T63.062S Toxic effect of venom of other North and South American snake, intentional self-harm, sequela
T63.063D Toxic effect of venom of other North and South American snake, assault, subsequent encounter
T63.063S Toxic effect of venom of other North and South American snake, assault, sequela
T63.064D Toxic effect of venom of other North and South American snake, undetermined, subsequent encounter
T63.064S Toxic effect of venom of other North and South American snake, undetermined, sequela
T63.071D Toxic effect of venom of other Australian snake, accidental (unintentional), subsequent encounter
T63.071S Toxic effect of venom of other Australian snake, accidental (unintentional), sequela
T63.072D Toxic effect of venom of other Australian snake, intentional self-harm, subsequent encounter
T63.072S Toxic effect of venom of other Australian snake, intentional self-harm, sequela
T63.073D Toxic effect of venom of other Australian snake, assault, subsequent encounter
T63.073S Toxic effect of venom of other Australian snake, assault, sequela
T63.074D Toxic effect of venom of other Australian snake, undetermined, subsequent encounter
T63.074S Toxic effect of venom of other Australian snake, undetermined, sequela
T63.081D Toxic effect of venom of other African and Asian snake, accidental (unintentional), subsequent encounter
T63.081S Toxic effect of venom of other African and Asian snake, accidental (unintentional), sequela
T63.082D Toxic effect of venom of other African and Asian snake, intentional self-harm, subsequent encounter
T63.082S Toxic effect of venom of other African and Asian snake, intentional self-harm, sequela
T63.083D Toxic effect of venom of other African and Asian snake, assault, subsequent encounter
T63.083S Toxic effect of venom of other African and Asian snake, assault, sequela
T63.084D Toxic effect of venom of other African and Asian snake, undetermined, subsequent encounter
T63.084S Toxic effect of venom of other African and Asian snake, undetermined, sequela
T63.091D Toxic effect of venom of other snake, accidental (unintentional), subsequent encounter
T63.091S Toxic effect of venom of other snake, accidental (unintentional), sequela
T63.092D Toxic effect of venom of other snake, intentional self-harm, subsequent encounter
T63.092S Toxic effect of venom of other snake, intentional self-harm, sequela
T63.093D Toxic effect of venom of other snake, assault, subsequent encounter
T63.093S Toxic effect of venom of other snake, assault, sequela
T63.094D Toxic effect of venom of other snake, undetermined, subsequent encounter
T63.094S Toxic effect of venom of other snake, undetermined, sequela
T63.111D Toxic effect of venom of gila monster, accidental (unintentional), subsequent encounter
T63.111S Toxic effect of venom of gila monster, accidental (unintentional), sequela
T63.112D Toxic effect of venom of gila monster, intentional self-harm, subsequent encounter
T63.112S Toxic effect of venom of gila monster, intentional self-harm, sequela
T63.113D Toxic effect of venom of gila monster, assault, subsequent encounter
T63.113S Toxic effect of venom of gila monster, assault, sequela
T63.114D Toxic effect of venom of gila monster, undetermined, subsequent encounter
T63.114S Toxic effect of venom of gila monster, undetermined, sequela
T63.121D Toxic effect of venom of other venomous lizard, accidental (unintentional), subsequent encounter
T63.121S Toxic effect of venom of other venomous lizard, accidental (unintentional), sequela
T63.122D Toxic effect of venom of other venomous lizard, intentional self-harm, subsequent encounter
T63.122S Toxic effect of venom of other venomous lizard, intentional self-harm, sequela
T63.123D Toxic effect of venom of other venomous lizard, assault, subsequent encounter
T63.123S Toxic effect of venom of other venomous lizard, assault, sequela
T63.124D Toxic effect of venom of other venomous lizard, undetermined, subsequent encounter
T63.124S Toxic effect of venom of other venomous lizard, undetermined, sequela
T63.191D Toxic effect of venom of other reptiles, accidental (unintentional), subsequent encounter
T63.191S Toxic effect of venom of other reptiles, accidental (unintentional), sequela
T63.192D Toxic effect of venom of other reptiles, intentional self-harm, subsequent encounter
T63.192S Toxic effect of venom of other reptiles, intentional self-harm, sequela
T63.193D Toxic effect of venom of other reptiles, assault, subsequent encounter
T63.193S Toxic effect of venom of other reptiles, assault, sequela
T63.194D Toxic effect of venom of other reptiles, undetermined, subsequent encounter
T63.194S Toxic effect of venom of other reptiles, undetermined, sequela
T63.2X1D Toxic effect of venom of scorpion, accidental (unintentional), subsequent encounter
T63.2X1S Toxic effect of venom of scorpion, accidental (unintentional), sequela
T63.2X2D Toxic effect of venom of scorpion, intentional self-harm, subsequent encounter
T63.2X2S Toxic effect of venom of scorpion, intentional self-harm, sequela
T63.2X3D Toxic effect of venom of scorpion, assault, subsequent encounter
T63.2X3S Toxic effect of venom of scorpion, assault, sequela
T63.2X4D Toxic effect of venom of scorpion, undetermined, subsequent encounter
T63.2X4S Toxic effect of venom of scorpion, undetermined, sequela
T63.301D Toxic effect of unspecified spider venom, accidental (unintentional), subsequent encounter
T63.301S Toxic effect of unspecified spider venom, accidental (unintentional), sequela
T63.302D Toxic effect of unspecified spider venom, intentional self-harm, subsequent encounter
T63.302S Toxic effect of unspecified spider venom, intentional self-harm, sequela
T63.303D Toxic effect of unspecified spider venom, assault, subsequent encounter
T63.303S Toxic effect of unspecified spider venom, assault, sequela
T63.304D Toxic effect of unspecified spider venom, undetermined, subsequent encounter
T63.304S Toxic effect of unspecified spider venom, undetermined, sequela
T63.311D Toxic effect of venom of black widow spider, accidental (unintentional), subsequent encounter
T63.311S Toxic effect of venom of black widow spider, accidental (unintentional), sequela
T63.312D Toxic effect of venom of black widow spider, intentional self-harm, subsequent encounter
T63.312S Toxic effect of venom of black widow spider, intentional self-harm, sequela
T63.313D Toxic effect of venom of black widow spider, assault, subsequent encounter
T63.313S Toxic effect of venom of black widow spider, assault, sequela
T63.314D Toxic effect of venom of black widow spider, undetermined, subsequent encounter
T63.314S Toxic effect of venom of black widow spider, undetermined, sequela
T63.321D Toxic effect of venom of tarantula, accidental (unintentional), subsequent encounter
T63.321S Toxic effect of venom of tarantula, accidental (unintentional), sequela
T63.322D Toxic effect of venom of tarantula, intentional self-harm, subsequent encounter
T63.322S Toxic effect of venom of tarantula, intentional self-harm, sequela
T63.323D Toxic effect of venom of tarantula, assault, subsequent encounter
T63.323S Toxic effect of venom of tarantula, assault, sequela
T63.324D Toxic effect of venom of tarantula, undetermined, subsequent encounter
T63.324S Toxic effect of venom of tarantula, undetermined, sequela
T63.331D Toxic effect of venom of brown recluse spider, accidental (unintentional), subsequent encounter
T63.331S Toxic effect of venom of brown recluse spider, accidental (unintentional), sequela
T63.332D Toxic effect of venom of brown recluse spider, intentional self-harm, subsequent encounter
T63.332S Toxic effect of venom of brown recluse spider, intentional self-harm, sequela
T63.333D Toxic effect of venom of brown recluse spider, assault, subsequent encounter
T63.333S Toxic effect of venom of brown recluse spider, assault, sequela
T63.334D Toxic effect of venom of brown recluse spider, undetermined, subsequent encounter
T63.334S Toxic effect of venom of brown recluse spider, undetermined, sequela
T63.391D Toxic effect of venom of other spider, accidental (unintentional), subsequent encounter
T63.391S Toxic effect of venom of other spider, accidental (unintentional), sequela
T78.2XXD Anaphylactic shock, unspecified, subsequent encounter
T78.2XXS Anaphylactic shock, unspecified, sequela
T78.3XXD Angioneurotic edema, subsequent encounter
T78.3XXS Angioneurotic edema, sequela
T88.6XXD Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, subsequent encounter
T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela
Z51.6* Encounter for desensitization to allergens
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Note: Z51.6* should not be billed as a primary diagnosis code on the claim.

Group 3

(32 Codes)
Group 3 Paragraph

Medicare is establishing limited coverage for CPT/HCPCS code 95004 for food allergies.

 

Group 3 Codes
Code Description
J30.5 Allergic rhinitis due to food
J38.4 Edema of larynx
J39.3 Upper respiratory tract hypersensitivity reaction, site unspecified
K20.0 Eosinophilic esophagitis
K52.29 Other allergic and dietetic gastroenteritis and colitis
L27.2 Dermatitis due to ingested food
L50.0 Allergic urticaria
R06.02 Shortness of breath
R06.2 Wheezing
T78.00XD Anaphylactic reaction due to unspecified food, subsequent encounter
T78.00XS Anaphylactic reaction due to unspecified food, sequela
T78.01XD Anaphylactic reaction due to peanuts, subsequent encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XD Anaphylactic reaction due to shellfish (crustaceans), subsequent encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XD Anaphylactic reaction due to other fish, subsequent encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XD Anaphylactic reaction due to fruits and vegetables, subsequent encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XD Anaphylactic reaction due to tree nuts and seeds, subsequent encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XD Anaphylactic reaction due to food additives, subsequent encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XD Anaphylactic reaction due to milk and dairy products, subsequent encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XD Anaphylactic reaction due to eggs, subsequent encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XD Anaphylactic reaction due to other food products, subsequent encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.3XXD Angioneurotic edema, subsequent encounter
T78.3XXS Angioneurotic edema, sequela
Z51.6* Encounter for desensitization to allergens
Group 3 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Note: Z51.6* should not be billed as a primary diagnosis code on the claim.

N/A

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

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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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N/A

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.

Code Description

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N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

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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
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
07/01/2024 R10

Under CPT/HCPCS Codes Group 2: Codes the description was revised for 95024. This revision is due to the Q3 2024 CPT/HCPCS Code Update and is effective for dates of service on or after 7/1/24.

04/01/2024 R9

Under CPT/HCPCS Codes Group 2: Codes the description was revised for 95024. This revision is due to the Q2 2024 CPT/HCPCS Code Update and is effective for dates of service on or after 4/1/24.

02/29/2024 R8

Under CMS National Coverage Policy updated section headings for regulations.

10/01/2023 R7

Under ICD-10-CM Codes that Support Medical Necessity Group 2: Codes added J44.81 and J44.89. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/23.

10/01/2021 R6

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes the description was revised for T63.611D, T63.611S, T63.612D, T63.612S, T63.613D, T63.613S, T63.614D, and T63.614S. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/2021.

06/24/2021 R5

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes added T50.B95A, T50.B95D, T50.B95S, T88.1XXA, T88.1XXD and T88.1XXS. This revision is retroactive effective for dates of service on or after 6/24/21.

10/01/2020 R4

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added J82.83. Under ICD-10 Codes that Support Medical Necessity Group 2: Codes added J82.83. This revision is due to the Annual ICD-10 Code Update and is effective on 10/1/20.

10/10/2019 R3

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Allergy Skin Testing L33417 LCD and placed in this article. Under ICD-10 Codes that Support Medical Necessity Group 1, 2, and 3: Paragraph removed Group 1, 2, and 3: Asterisk subheading and corresponding paragraph. Under ICD-10 Codes that Support Medical Necessity Group 1, 2, and 3: Codes placed an asterisk on ICD-10 code Z51.6. Under ICD-10 Codes that Support Medical Necessity Group 1, 2, and 3: Medical Necessity ICD-10 Codes Asterisk Explanation added verbiage.

10/01/2019 R2

Under Covered ICD-10 Codes Group 1: Codes ICD-10 codes T78.00XD, T78.00XS, T78.01XD, T78.01XS, T78.02XD, T78.02XS, T78.03XD, T78.03XS, T78.04XD, T78.04XS, T78.05XD, T78.05XS, T78.06XD, T78.06XS, T78.07XD, T78.07XS, T78.08XD, T78.08XS, T78.09XD, T78.09XS were added.

Under Covered ICD-10 Codes Group 1 and 2: Codes the description changed for ICD-10 code J44.0. This description change is due to the 2019 Annual ICD-10 Code Update.

05/16/2019 R1

All coding located in the Coding Information section has been removed from the related Allergy Skin Testing L33417 LCD and added to this article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33417 - Allergy Skin Testing
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
06/19/2024 07/01/2024 - N/A Currently in Effect You are here
03/18/2024 04/01/2024 - 06/30/2024 Superseded View
02/21/2024 02/29/2024 - 03/31/2024 Superseded View
08/22/2023 10/01/2023 - 02/28/2024 Superseded View
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Keywords

  • Allergy Skin Testing