2025 CPT code 86003
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Pathology and Laboratory Feed
Allergen-specific IgE; quantitative or semiquantitative, crude allergen extract, each. This test measures the amount of immunoglobulin E (IgE) antibodies in response to specific crude allergen extracts.
Modifiers may be applicable.Modifier 90 is used if the test is performed by an outside laboratory. Modifier 91 is used for repeat testing. Modifier 99 indicates multiple modifiers.
Medical necessity for this test is based on the patient's clinical presentation and the suspicion of an IgE-mediated allergy to specific substances. Payer policies may vary, and some may require pre-authorization or limit the number of allergens that can be tested.
The laboratory analyst performs the technical aspects of the test, including mixing the patient's serum with the allergen, adding reagents, and interpreting the results.
In simple words: This blood test helps identify allergies by measuring the amount of IgE antibodies your body makes in response to specific allergy-causing substances.It's typically used to check for allergies to things like foods, drugs, or environmental triggers. The test is done separately for each substance, so you might have several results if you're being tested for multiple allergies.
This test analyzes a specimen, such as serum, for allergen-specific immunoglobulin E (IgE) using a crude allergen extract. The result is either quantitative (giving a specific amount) or semiquantitative (giving an estimated amount).The test is performed for each individual crude allergen extract, and the code is reported per allergen tested. This test is distinct from testing with purified or recombinant allergen components (86008) or skin prick allergy testing (95004).
Example 1: A patient presents with suspected food allergies.The physician orders 86003 for several crude allergen extracts, including milk, egg, and peanut, to determine the specific IgE levels for each., A child experiences recurrent hives after playing outdoors. To identify potential environmental allergies, the physician orders 86003 for pollen, dust mites, and mold., An adult develops a rash after starting a new medication.The physician orders 86003 using a crude extract of the suspected drug to determine if an IgE-mediated allergy is present.
The documentation should include the specific crude allergen extracts tested, the quantitative or semiquantitative results, the patient's symptoms, and the reason for testing (e.g., suspected allergy).
** Check with individual payers regarding coverage limitations and medical necessity requirements for this code, as policies may vary. As of December 1st, 2024, some payers limit coverage of this code to 30 units per year.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Specialties:Allergy and Immunology, Family Medicine, Pediatrics, Internal Medicine
- Place of Service:Office, Independent Laboratory, Outpatient Hospital