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Medical Policy Update: Allergy Testing

Effective May 21, 2018, the guidelines of our medical policy, Allergy Testing, will also be applied to claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Allergy Testing. Beginning May 21, 2018, the guidelines of this policy will also apply to patients enrolled in Horizon BCBSNJ MA plans.


Based on the guidelines of our medical policy, Allergy Testing, claims for services provided on and after May 21, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • Based on the submitted diagnosis code(s), claims that include CPT® codes 82785, 86003, 95004, 95017, 95018, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076 and 95079 may pend while information required to determine medical appropriateness is requested and reviewed.

  • Based on the submitted diagnosis code(s), CPT code 82785 may be denied as non-covered service under the member's benefit plan.

  • Based on the submitted diagnosis code(s), CPT codes 86003, 95004, 95017, 95018, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95076 and 95079 may be denied as services "not related" to the submitted diagnosis code(s).

  • Regardless of the submitted diagnosis code(s), CPT codes 86001 and 86005 will be denied as experimental/investigational non-covered services.

  • Regardless of the submitted diagnosis code(s), CPT code 86343 will be denied as a non-covered service under the member's benefit plan.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims on and after May 21, 2018.

CPT® is a registered mark of the American Medical Association.

Published on: April 18, 2018, 11:49 a.m. ET
Last updated on: April 18, 2018, 12:52 p.m. ET