Local Coverage Determination (LCD)

RAST Type Tests

L33591

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L33591
Original ICD-9 LCD ID
Not Applicable
LCD Title
RAST Type Tests
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 11/07/2019
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A

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Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Issue

Issue Description
Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

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.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous tests are in vitro techniques for determining whether a patient's serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient.

The multiple antigen simultaneous testing technique is similar to the RAST/FAST techniques in that it depends upon the existence of allergic antibodies in the blood of the patient being tested. With the multiple antigen simultaneous test system, several antigens may be used to test for specific IgE simultaneously.

ELISA (enzyme-linked immunosorbent assay) is another in vitro method of allergy testing for specific IgE antibodies against allergens. This method is also a variation of RAST.

Limitations:

The following tests are considered to be not medically necessary and will be denied.

  • ELISA/Act qualitative antibody testing
    This testing is used to determine in vitro reaction to various foods and relies on lymphocyte blastogenesis in response to certain food antigens.
  • LMRA (Lymphocyte Mitogen Response Assays) by ELISA/Act
  • IgG ELISA, indirect method
  • Qualitative multi-allergen screen
    This is a non-specific test that does not identify a specific antigen.
  • IgG and IgG subclass antibody tests for food allergy do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed.

 

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
View Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

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

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

Additional ICD-10 Information

General Information

Associated Information
N/A
Sources of Information
N/A
Bibliography

This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

Adkinson NF, Yunginger JW, Busse WW, et al Middleton’s Allergy: Principles and Practice, 6th ed.

American College of Asthma, Allergy & Immunology (ACAAI). Practice Parameters for Allergy Diagnostic Testing. 1998.

Bernstein LI, Li JT, Bernstein DI et al, Practice Parameters for Allergy Diagnostic Testing: An Updated Practice Parameter. March 2008;100:S1-S148.

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
11/07/2019 R5

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56844. There has been no change in coverage with this LCD revision.

  • Revisions Due To Code Removal
01/01/2018 R4

Based on the 2018 annual HCPCS update, CPT code 86008 has been added to the CPT/HCPCS section and to the Group 1 paragraph for ICD-10 Codes that support Medical Necessity and the descriptions for CPT codes 86003 and 86005 have been revised.

DATE (01/01/2018): At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To CPT/HCPCS Code Changes
10/01/2015 R3 The ICD-10 range T78.01XA-T78.49XS has been broken out to remove ICD-10 codes T78.1XXA-T78.1XXS and T78.41XA-T78.41XS.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 The following ICD-10 codes have been added: T36.0X5A - T36.0X5S, T36.1X5A - T36.1X5S, T36.2X5A - T36.2X5S, T36.3X5A - T36.3X5S, T36.4X5A - T36.4X5S, T36.5X5A - T36.5X5S, T36.6X5A - T36.6X5S, T36.7X5A - T36.7X5S, T36.8X5A - T36.8X5S, T36.95XA - T36.95XS, T37.0X5A - T37.0X5S, T37.1X5A - T37.1X5S, T37.2X5A - T37.2X5S, T37.3X5A - T37.3X5S, T37.4X5A - T37.4X5S, T37.5X5A - T37.5X5S, T37.8X5A - T37.8X5S, T37.95XA - T37.95XS,T38.0X5A - T38.0X5S, T38.1X5A - T38.1X5S, T38.2X5A - T38.2X5S, T38.4X5A - T38.4X5S, T38.5X5A - T38.5X5S, T38.6X5A - T38.6X5S, T38.7X5A - T38.7X5S, T38.805A - T38.805S, T38.815A - T38.815S, T38.895A - T38.895S, T38.905A - T38.905S, T38.995A - T38.995S, T39.015A - T39.015S, T39.095A - T39.095S, T39.1X5A - T39.1X5S, T39.2X5A - T39.2X5S, T39.315A - T39.315S, T39.395A - T39.395S, T39.4X5A - T39.4X5S, T39.8X5A - T39.8X5S, T39.95XA - T39.95XS, T40.0X5A - T40.0X5S, T40.2X5A - T40.2X5S, T40.3X5A - T40.3X5S, T40.4X5A - T40.4X5S, T40.5X5A - T40.5X5S, T40.605A - T40.605S, T40.695A - T40.695S, T40.7X5A - T40.7X5S, T40.905A - T40.905S, T40.995A - T40.995S, T41.0X5A - T41.0X5S, T41.1X5A - T41.1X5S, T41.295A - T41.295S, T41.3X5A - T41.3X5S, T41.5X5A - T41.5X5S, T42.0X5A - T42.0X5S, T42.1X5A - T42.1X5S, T42.2X5A - T42.2X5S, T42.3X5A - T42.3X5S, T42.4X5A - T42.4X5S, T42.5X5A - T42.5X5S, T42.6X5A - T42.6X5S, T42.75XA - T42.75XS, T42.8X5A - T42.8X5S, T43.015A - T43.015S, T43.025A - T43.025S, T43.1X5A - T43.1X5S, T43.205A - T43.205S, T43.215A - T43.215S, T43.225A - T43.225S, T43.295A - T43.295S, T43.3X5A - T43.3X5S, T43.4X5A - T43.4X5S, T43.505A - T43.505S, T43.595A - T43.595S, T43.605A - T43.605S, T43.615A - T43.615S, T43.625A - T43.625S, T43.635A - T43.635S, T43.695A - T43.695S, T43.8X5A - T43.8X5S, T43.95XA - T43.95XS, T44.0X5A - T44.0X5S, T44.1X5A - T44.1X5S, T44.2X5A - T44.2X5S, T44.3X5A - T44.3X5S, T44.4X5A - T44.4X5S, T44.5X5A - T44.5X5S, T44.6X5A - T44.6X5S, T44.7X5A - T44.7X5S, T44.8X5A - T44.8X5S, T44.905A - T44.905S, T44.995A - T44.995S, T45.0X5A - T45.0X5S, T45.1X5A - T45.1X5S, T45.2X5A - T45.2X5S, T45.3X5A - T45.3X5S, T45.4X5A - T45.4X5S, T45.515A - T45.515S, T45.525A - T45.525S, T45.605A - T45.605S, T45.615A - T45.615S, T45.625A - T45.625S, T45.695A - T45.695S, T45.7X5A - T45.7X5S, T45.8X5A - T45.8X5S, T45.95XA - T45.95XS, T46.0X5A - T46.0X5S, T46.1X5A - T46.1X5S, T46.2X5A - T46.2X5S, T46.3X5A - T46.3X5S, T46.4X5A - T46.4X5S, T46.5X5A - T46.5X5S, T46.6X5A - T46.6X5S, T46.7X5A - T46.7X5S, T46.8X5A - T46.8X5S, T46.905A - T46.905S, T46.995A - T46.995S, T47.0X5A - T47.0X5S, T47.1X5A - T47.1X5S, T47.2X5A - T47.2X5S, T47.3X5A - T47.3X5S, T47.4X5A - T47.4X5S, T47.5X5A - T47.5X5S, T47.6X5A - T47.6X5S, T47.7X5A - T47.7X5S, T47.8X5A - T47.8X5S, T47.95XA - T47.95XS, T48.0X5A - T48.0X5S, T48.1X5A - T48.1X5S, T48.205A - T48.205S, T48.295A - T48.295S, T48.3X5A - T48.3X5S, T48.4X5A - T48.4X5S, T48.5X5A - T48.5X5S, T48.6X5A - T48.6X5S, T48.905A - T48.905S, T48.995A - T48.995S, T49.0X5A - T49.0X5S, T49.1X5A - T49.1X5S, T49.2X5A - T49.2X5S, T49.3X5A - T49.3X5S, T49.4X5A - T49.4X5S, T49.5X5A - T49.5X5S, T49.6X5A - T49.6X5S, T49.7X5A - T49.7X5S, T49.8X5A - T49.8X5S, T49.95XA - T49.95XS, T50.0X5A - T50.0X5S, T50.1X5A - T50.1X5S, T50.2X5A - T50.2X5S, T50.3X5A - T50.3X5S, T50.4X5A - T50.4X5S, T50.5X5A - T50.5X5S, T50.6X5A - T50.6X5S, T50.7X5A - T50.7X5S, T50.8X5A - T50.8X5S, T50.A15A - T50.A15S, T50.A25A - T50.A25S, T50.A95A - T50.A95S, T50.B15A - T50.B15S, T50.B95A - T50.B95S, T50.Z15A - T50.Z15S, T50.Z95A - T50.Z95S, T50.905A - T50.905S, T50.995A - T50.995S, T63.011A - T63.044S, T63.061A - T63.093S, T63.094D, T63.094S, T63.111A - T63.124S, T63.191A - T63.194S, T63.2X1A - T63.2X4S, T63.311A - T63.334S, T63.391A - T63.394S, T63.411A – T63.483S, T63.484D, T63.484S, T63.511A - T63.514S, T63.591A - T63.594S, T63.611A - T63.634S, T63.691A – T63.693S, T63.694D, T63.694S, T63.711A - T63.714S, T63.791A – T63.793S, T63.794D, T63.794S, T63.811A - T63.834S, T63.891A - T63.894S, T78.00XA - 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, T78.2XXD, T78.2XXS, T78.3XXD, T78.3XXS, T78.40XD, T78.40XS, T78.49XD, T78.49XS. T88.6XXA – T88.6XXS.
The following ICD-10 codes have been removed: T63.91XA - T63.94XA and T88.59XA.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R1 Add Bill type codes
  • Other
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Associated Documents

Attachments
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Related Local Coverage Documents
Articles
A56844 - Billing and Coding: RAST Type Tests
Related National Coverage Documents
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Public Versions
Updated On Effective Dates Status
11/01/2019 11/07/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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