2025 CPT code 86005
(Active) Effective Date: N/A Revision Date: N/A Qualitative or Semiquantitative Immunoassays - Immunology Pathology and Laboratory Feed
Allergen specific IgE; qualitative, multiallergen screen (e.g., disk, sponge, card).
Modifiers may be applicable to this code.Modifier 59 may be used to indicate a distinct procedural service. Modifier 90 indicates that the test was performed by a reference (outside) laboratory.
Medical necessity for this code may be questioned by some payers. It's considered medically necessary in situations where skin testing is contraindicated, such as severe skin conditions, risk of anaphylaxis, or inconclusive skin test results. Clear documentation of the medical reason for performing this test instead of skin testing is essential.
The lab analyst performs all technical steps to detect the presence of allergen-specific IgE in serum. This involves testing for more than one allergen at a time using a device such as a sponge, card, or disk that provides a qualitative result. The specimen used for this test is serum.
In simple words: This test checks your blood for allergic reactions to many things at once. It tells you if you have any of these allergies, but not how strong they are.It's like a quick check to see if you need more allergy tests.
This code represents a qualitative test for allergen-specific IgE using a multi-allergen screening tool like a disk, sponge, or card.It identifies the presence or absence of IgE antibodies to multiple allergens simultaneously, providing a qualitative (positive or negative) result, not a specific quantity.
Example 1: A young child with eczema and widespread skin lesions where direct skin testing may be problematic., A patient with suspected allergies where the specific allergen is unknown., A patient with a history of anaphylactic reactions to skin testing, requiring an alternative method for allergy testing.
Documentation should include the reason for the test, such as symptoms or suspected allergies, and any contraindications to skin testing. A detailed clinical history is crucial, especially in cases where skin testing is not feasible.
** While this test provides a broad overview of potential allergies, it doesn't quantify the level of sensitivity. Positive results may warrant further investigation with more specific allergy tests.Note: Reimbursement policies for this code vary depending on the payer. Some payers may consider this a screening test and deny coverage. Consult iFrameAI for updated, real-time payer policies. As of today's date, December 1, 2024, this information is current, but coding guidelines and payer policies can change.Always verify the latest information before submitting claims.
- Specialties:Allergy and Immunology, Family Medicine, Pediatrics, Internal Medicine
- Place of Service:Independent Laboratory, Office