POLICY/CRITERIA

The following allergy tests are covered benefits:

1. IgE Specific Antibody (e.g., RAST, micro-Elisa, immunocap) if clinically indicated for history of severe urticaria, hives, or severe allergy, when skin testing is inappropriate. 

2. Skin tests (scratch, intradermal, pricks) 

3. Patch application tests 

4. Drug Provocation testing 

5. Skin Endpoint Titration (SET). Skin endpoint titration is effective for quantifying patient sensitivity and for providing a safe starting dose for immunotherapy. SET has not been shown to be an effective guide to a final therapeutic dose. 

6. Nitric Oxide Breath Analysis for the management of asthma. 

The following services have not been proven to be effective in diagnosing and/or treating allergies, and are not covered benefits:

1. Cytotoxicity testing (Bryan's test)

2. Urine autoinjection (autogenous urine immunization) 

3. Provocation testing and neutralization therapy for food allergy (intracutaneous, subcutaneous or sublingually). Also called Intracutaneous Progressive Dilution Food Test (IPDFT).  

4. Antigen leukocyte cellular antibody test (ALCAT) for all indications including but not limited to testing for food allergies or intolerance (chemical sensitivities) and as a tool to establish elimination diets. 

5. Electrodermal testing or electro-acupuncture*

6. Applied kinesiology or muscle strength testing of allergies 

7. Reaginic pulse testing or pulse testing for allergies 

8. Total serum immunoglobulin G (IgG), immunoglobulin A (IgA) and immunoglobulin M (IgM) 

9. Testing of specific IgG antibody (e.g., by RAST or ELISA testing) 

10. Lymphocyte subset counts 

11. Lymphocyte function assay 

12. Lymphocyte transformation test (LTT), also known as lymphocyte proliferation test and metal ion testing for metal-induced hypersensitivity response. 

13. Cytokine, cytokine receptor assay and Th1/Th2 cytokine ratio 

14. Natural Killer (NK) cell assay or activity 

15. Food immune complex assay (FICA)

16. Leukocyte histamine release testing 

17. Body chemical analysis 

18. Sublingual immunotherapy (SLIT) as an alternative way to treat allergies without injections. SLIT is not FDA approved in the United States 

19. Nitric Oxide Breath Analysis for the diagnosis of asthma  

*Note: Acupuncture may be covered with a rider for some commercial plans. 

DESCRIPTION 

Allergy testing, evaluations, and immunotherapy are eligible for coverage according to the schedule of covered services in plan documents. Testing or treatment methods not considered as standard medical procedures are not eligible for coverage.