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LCD Reference Article Billing and Coding Article

Billing and Coding: RAST Type Tests

A56844

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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General Information

Source Article ID
N/A
Article ID
A56844
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: RAST Type Tests
Article Type
Billing and Coding
Original Effective Date
11/07/2019
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for RAST Type Tests.

Coding Information:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Each claim must be submitted with ICD-10-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-10-CM codes will be returned.

Documentation must be available to Medicare upon request.

Utilization Guidelines:

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

 

Response To Comments

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Coding Information

Bill Type Codes

Code Description
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Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

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Group 1

(4 Codes)
Group 1 Paragraph

CPT codes 86001 and 86005 are not covered services.

Group 1 Codes
Code Description
86001 ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH
86005 ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (EG, DISK, SPONGE, CARD)
86008 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, RECOMBINANT OR PURIFIED COMPONENT, EACH
N/A

CPT/HCPCS Modifiers

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Group 1

Group 1 Paragraph

N/A

 Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(996 Codes)
Group 1 Paragraph

The use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the determination.

The following ICD-10 Codes apply to CPT codes 86003 and 86008:

 Group 1 Codes
Code Description
J30.0 Vasomotor rhinitis
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.5 Allergic rhinitis due to food
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J30.9 Allergic rhinitis, unspecified
J45.20 Mild intermittent asthma, uncomplicated
J45.21 Mild intermittent asthma with (acute) exacerbation
J45.22 Mild intermittent asthma with status asthmaticus
J45.30 Mild persistent asthma, uncomplicated
J45.31 Mild persistent asthma with (acute) exacerbation
J45.32 Mild persistent asthma with status asthmaticus
J45.40 Moderate persistent asthma, uncomplicated
J45.41 Moderate persistent asthma with (acute) exacerbation
J45.42 Moderate persistent asthma with status asthmaticus
J45.50 Severe persistent asthma, uncomplicated
J45.51 Severe persistent asthma with (acute) exacerbation
J45.52 Severe persistent asthma with status asthmaticus
J45.901 Unspecified asthma with (acute) exacerbation
J45.902 Unspecified asthma with status asthmaticus
J45.909 Unspecified asthma, uncomplicated
J45.991 Cough variant asthma
J45.998 Other asthma
L20.0 Besnier's prurigo
L20.81 Atopic neurodermatitis
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L50.0 Allergic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
L50.9 Urticaria, unspecified
R06.2 Wheezing
T36.0X5A - T36.0X5S Adverse effect of penicillins, initial encounter - Adverse effect of penicillins, sequela
T36.1X5A - T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter - Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.2X5A - T36.2X5S Adverse effect of chloramphenicol group, initial encounter - Adverse effect of chloramphenicol group, sequela
T36.3X5A - T36.3X5S Adverse effect of macrolides, initial encounter - Adverse effect of macrolides, sequela
T36.4X5A - T36.4X5S Adverse effect of tetracyclines, initial encounter - Adverse effect of tetracyclines, sequela
T36.5X5A - T36.5X5S Adverse effect of aminoglycosides, initial encounter - Adverse effect of aminoglycosides, sequela
T36.6X5A - T36.6X5S Adverse effect of rifampicins, initial encounter - Adverse effect of rifampicins, sequela
T36.7X5A - T36.7X5S Adverse effect of antifungal antibiotics, systemically used, initial encounter - Adverse effect of antifungal antibiotics, systemically used, sequela
T36.8X5A - T36.8X5S Adverse effect of other systemic antibiotics, initial encounter - Adverse effect of other systemic antibiotics, sequela
T36.95XA - T36.95XS Adverse effect of unspecified systemic antibiotic, initial encounter - Adverse effect of unspecified systemic antibiotic, sequela
T37.0X5A - T37.0X5S Adverse effect of sulfonamides, initial encounter - Adverse effect of sulfonamides, sequela
T37.1X5A - T37.1X5S Adverse effect of antimycobacterial drugs, initial encounter - Adverse effect of antimycobacterial drugs, sequela
T37.2X5A - T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter - Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.3X5A - T37.3X5S Adverse effect of other antiprotozoal drugs, initial encounter - Adverse effect of other antiprotozoal drugs, sequela
T37.4X5A - T37.4X5S Adverse effect of anthelminthics, initial encounter - Adverse effect of anthelminthics, sequela
T37.5X5A - T37.5X5S Adverse effect of antiviral drugs, initial encounter - Adverse effect of antiviral drugs, sequela
T37.8X5A - T37.8X5S Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter - Adverse effect of other specified systemic anti-infectives and antiparasitics, sequela
T37.95XA - T37.95XS Adverse effect of unspecified systemic anti-infective and antiparasitic, initial encounter - Adverse effect of unspecified systemic anti-infective and antiparasitic, sequela
T38.0X5A - T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, initial encounter - Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.1X5A - T38.1X5S Adverse effect of thyroid hormones and substitutes, initial encounter - Adverse effect of thyroid hormones and substitutes, sequela
T38.2X5A - T38.2X5S Adverse effect of antithyroid drugs, initial encounter - Adverse effect of antithyroid drugs, sequela
T38.4X5A - T38.4X5S Adverse effect of oral contraceptives, initial encounter - Adverse effect of oral contraceptives, sequela
T38.5X5A - T38.5X5S Adverse effect of other estrogens and progestogens, initial encounter - Adverse effect of other estrogens and progestogens, sequela
T38.6X5A - T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter - Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.7X5A - T38.7X5S Adverse effect of androgens and anabolic congeners, initial encounter - Adverse effect of androgens and anabolic congeners, sequela
T38.805A - T38.805S Adverse effect of unspecified hormones and synthetic substitutes, initial encounter - Adverse effect of unspecified hormones and synthetic substitutes, sequela
T38.815A - T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter - Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.895A - T38.895S Adverse effect of other hormones and synthetic substitutes, initial encounter - Adverse effect of other hormones and synthetic substitutes, sequela
T38.905A - T38.905S Adverse effect of unspecified hormone antagonists, initial encounter - Adverse effect of unspecified hormone antagonists, sequela
T38.995A - T38.995S Adverse effect of other hormone antagonists, initial encounter - Adverse effect of other hormone antagonists, sequela
T39.015A - T39.015S Adverse effect of aspirin, initial encounter - Adverse effect of aspirin, sequela
T39.095A - T39.095S Adverse effect of salicylates, initial encounter - Adverse effect of salicylates, sequela
T39.1X5A - T39.1X5S Adverse effect of 4-Aminophenol derivatives, initial encounter - Adverse effect of 4-Aminophenol derivatives, sequela
T39.2X5A - T39.2X5S Adverse effect of pyrazolone derivatives, initial encounter - Adverse effect of pyrazolone derivatives, sequela
T39.315A - T39.315S Adverse effect of propionic acid derivatives, initial encounter - Adverse effect of propionic acid derivatives, sequela
T39.395A - T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter - Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.4X5A - T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, initial encounter - Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.8X5A - T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter - Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T39.95XA - T39.95XS Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, initial encounter - Adverse effect of unspecified nonopioid analgesic, antipyretic and antirheumatic, sequela
T40.0X5A - T40.0X5S Adverse effect of opium, initial encounter - Adverse effect of opium, sequela
T40.2X5A - T40.2X5S Adverse effect of other opioids, initial encounter - Adverse effect of other opioids, sequela
T40.3X5A - T40.3X5S Adverse effect of methadone, initial encounter - Adverse effect of methadone, sequela
T40.495A - T40.495S Adverse effect of other synthetic narcotics, initial encounter - Adverse effect of other synthetic narcotics, sequela
T40.5X5A - T40.5X5S Adverse effect of cocaine, initial encounter - Adverse effect of cocaine, sequela
T40.605A - T40.605S Adverse effect of unspecified narcotics, initial encounter - Adverse effect of unspecified narcotics, sequela
T40.695A - T40.695S Adverse effect of other narcotics, initial encounter - Adverse effect of other narcotics, sequela
T40.715A - T40.715S Adverse effect of cannabis, initial encounter - Adverse effect of cannabis, sequela
T40.905A - T40.905S Adverse effect of unspecified psychodysleptics [hallucinogens], initial encounter - Adverse effect of unspecified psychodysleptics [hallucinogens], sequela
T40.995A - T40.995S Adverse effect of other psychodysleptics [hallucinogens], initial encounter - Adverse effect of other psychodysleptics [hallucinogens], sequela
T41.0X5A - T41.0X5S Adverse effect of inhaled anesthetics, initial encounter - Adverse effect of inhaled anesthetics, sequela
T41.1X5A - T41.1X5S Adverse effect of intravenous anesthetics, initial encounter - Adverse effect of intravenous anesthetics, sequela
T41.295A - T41.295S Adverse effect of other general anesthetics, initial encounter - Adverse effect of other general anesthetics, sequela
T41.3X5A - T41.3X5S Adverse effect of local anesthetics, initial encounter - Adverse effect of local anesthetics, sequela
T41.5X5A - T41.5X5S Adverse effect of therapeutic gases, initial encounter - Adverse effect of therapeutic gases, sequela
T42.0X5A - T42.0X5S Adverse effect of hydantoin derivatives, initial encounter - Adverse effect of hydantoin derivatives, sequela
T42.1X5A - T42.1X5S Adverse effect of iminostilbenes, initial encounter - Adverse effect of iminostilbenes, sequela
T42.2X5A - T42.2X5S Adverse effect of succinimides and oxazolidinediones, initial encounter - Adverse effect of succinimides and oxazolidinediones, sequela
T42.3X5A - T42.3X5S Adverse effect of barbiturates, initial encounter - Adverse effect of barbiturates, sequela
T42.4X5A - T42.4X5S Adverse effect of benzodiazepines, initial encounter - Adverse effect of benzodiazepines, sequela
T42.5X5A - T42.5X5S Adverse effect of mixed antiepileptics, initial encounter - Adverse effect of mixed antiepileptics, sequela
T42.6X5A - T42.6X5S Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter - Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela
T42.75XA - T42.75XS Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, initial encounter - Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, sequela
T42.8X5A - T42.8X5S Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter - Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela
T43.015A - T43.015S Adverse effect of tricyclic antidepressants, initial encounter - Adverse effect of tricyclic antidepressants, sequela
T43.025A - T43.025S Adverse effect of tetracyclic antidepressants, initial encounter - Adverse effect of tetracyclic antidepressants, sequela
T43.1X5A - T43.1X5S Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter - Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela
T43.205A - T43.205S Adverse effect of unspecified antidepressants, initial encounter - Adverse effect of unspecified antidepressants, sequela
T43.215A - T43.215S Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter - Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela
T43.225A - T43.225S Adverse effect of selective serotonin reuptake inhibitors, initial encounter - Adverse effect of selective serotonin reuptake inhibitors, sequela
T43.295A - T43.295S Adverse effect of other antidepressants, initial encounter - Adverse effect of other antidepressants, sequela
T43.3X5A - T43.3X5S Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter - Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela
T43.4X5A - T43.4X5S Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter - Adverse effect of butyrophenone and thiothixene neuroleptics, sequela
T43.505A - T43.505S Adverse effect of unspecified antipsychotics and neuroleptics, initial encounter - Adverse effect of unspecified antipsychotics and neuroleptics, sequela
T43.595A - T43.595S Adverse effect of other antipsychotics and neuroleptics, initial encounter - Adverse effect of other antipsychotics and neuroleptics, sequela
T43.605A - T43.605S Adverse effect of unspecified psychostimulants, initial encounter - Adverse effect of unspecified psychostimulants, sequela
T43.615A - T43.615S Adverse effect of caffeine, initial encounter - Adverse effect of caffeine, sequela
T43.625A - T43.625S Adverse effect of amphetamines, initial encounter - Adverse effect of amphetamines, sequela
T43.635A - T43.635S Adverse effect of methylphenidate, initial encounter - Adverse effect of methylphenidate, sequela
T43.695A - T43.695S Adverse effect of other psychostimulants, initial encounter - Adverse effect of other psychostimulants, sequela
T43.8X5A - T43.8X5S Adverse effect of other psychotropic drugs, initial encounter - Adverse effect of other psychotropic drugs, sequela
T43.95XA - T43.95XS Adverse effect of unspecified psychotropic drug, initial encounter - Adverse effect of unspecified psychotropic drug, sequela
T44.0X5A - T44.0X5S Adverse effect of anticholinesterase agents, initial encounter - Adverse effect of anticholinesterase agents, sequela
T44.1X5A - T44.1X5S Adverse effect of other parasympathomimetics [cholinergics], initial encounter - Adverse effect of other parasympathomimetics [cholinergics], sequela
T44.2X5A - T44.2X5S Adverse effect of ganglionic blocking drugs, initial encounter - Adverse effect of ganglionic blocking drugs, sequela
T44.3X5A - T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter - Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.4X5A - T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter - Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.5X5A - T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter - Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.6X5A - T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, initial encounter - Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.7X5A - T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, initial encounter - Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.8X5A - T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter - Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.905A - T44.905S Adverse effect of unspecified drugs primarily affecting the autonomic nervous system, initial encounter - Adverse effect of unspecified drugs primarily affecting the autonomic nervous system, sequela
T44.995A - T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter - Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T45.0X5A - T45.0X5S Adverse effect of antiallergic and antiemetic drugs, initial encounter - Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A - T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter - Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A - T45.2X5S Adverse effect of vitamins, initial encounter - Adverse effect of vitamins, sequela
T45.3X5A - T45.3X5S Adverse effect of enzymes, initial encounter - Adverse effect of enzymes, sequela
T45.4X5A - T45.4X5S Adverse effect of iron and its compounds, initial encounter - Adverse effect of iron and its compounds, sequela
T45.515A - T45.515S Adverse effect of anticoagulants, initial encounter - Adverse effect of anticoagulants, sequela
T45.525A - T45.525S Adverse effect of antithrombotic drugs, initial encounter - Adverse effect of antithrombotic drugs, sequela
T45.605A - T45.605S Adverse effect of unspecified fibrinolysis-affecting drugs, initial encounter - Adverse effect of unspecified fibrinolysis-affecting drugs, sequela
T45.615A - T45.615S Adverse effect of thrombolytic drugs, initial encounter - Adverse effect of thrombolytic drugs, sequela
T45.625A - T45.625S Adverse effect of hemostatic drug, initial encounter - Adverse effect of hemostatic drug, sequela
T45.695A - T45.695S Adverse effect of other fibrinolysis-affecting drugs, initial encounter - Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.7X5A - T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter - Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.8X5A - T45.8X5S Adverse effect of other primarily systemic and hematological agents, initial encounter - Adverse effect of other primarily systemic and hematological agents, sequela
T45.95XA - T45.95XS Adverse effect of unspecified primarily systemic and hematological agent, initial encounter - Adverse effect of unspecified primarily systemic and hematological agent, sequela
T46.0X5A - T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter - Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A - T46.1X5S Adverse effect of calcium-channel blockers, initial encounter - Adverse effect of calcium-channel blockers, sequela
T46.2X5A - T46.2X5S Adverse effect of other antidysrhythmic drugs, initial encounter - Adverse effect of other antidysrhythmic drugs, sequela
T46.3X5A - T46.3X5S Adverse effect of coronary vasodilators, initial encounter - Adverse effect of coronary vasodilators, sequela
T46.4X5A - T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter - Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.5X5A - T46.5X5S Adverse effect of other antihypertensive drugs, initial encounter - Adverse effect of other antihypertensive drugs, sequela
T46.6X5A - T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter - Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.7X5A - T46.7X5S Adverse effect of peripheral vasodilators, initial encounter - Adverse effect of peripheral vasodilators, sequela
T46.8X5A - T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter - Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.905A - T46.905S Adverse effect of unspecified agents primarily affecting the cardiovascular system, initial encounter - Adverse effect of unspecified agents primarily affecting the cardiovascular system, sequela
T46.995A - T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter - Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T47.0X5A - T47.0X5S Adverse effect of histamine H2-receptor blockers, initial encounter - Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A - T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter - Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.2X5A - T47.2X5S Adverse effect of stimulant laxatives, initial encounter - Adverse effect of stimulant laxatives, sequela
T47.3X5A - T47.3X5S Adverse effect of saline and osmotic laxatives, initial encounter - Adverse effect of saline and osmotic laxatives, sequela
T47.4X5A - T47.4X5S Adverse effect of other laxatives, initial encounter - Adverse effect of other laxatives, sequela
T47.5X5A - T47.5X5S Adverse effect of digestants, initial encounter - Adverse effect of digestants, sequela
T47.6X5A - T47.6X5S Adverse effect of antidiarrheal drugs, initial encounter - Adverse effect of antidiarrheal drugs, sequela
T47.7X5A - T47.7X5S Adverse effect of emetics, initial encounter - Adverse effect of emetics, sequela
T47.8X5A - T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter - Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T47.95XA - T47.95XS Adverse effect of unspecified agents primarily affecting the gastrointestinal system, initial encounter - Adverse effect of unspecified agents primarily affecting the gastrointestinal system, sequela
T48.0X5A - T48.0X5S Adverse effect of oxytocic drugs, initial encounter - Adverse effect of oxytocic drugs, sequela
T48.1X5A - T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter - Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.205A - T48.205S Adverse effect of unspecified drugs acting on muscles, initial encounter - Adverse effect of unspecified drugs acting on muscles, sequela
T48.295A - T48.295S Adverse effect of other drugs acting on muscles, initial encounter - Adverse effect of other drugs acting on muscles, sequela
T48.3X5A - T48.3X5S Adverse effect of antitussives, initial encounter - Adverse effect of antitussives, sequela
T48.4X5A - T48.4X5S Adverse effect of expectorants, initial encounter - Adverse effect of expectorants, sequela
T48.5X5A - T48.5X5S Adverse effect of other anti-common-cold drugs, initial encounter - Adverse effect of other anti-common-cold drugs, sequela
T48.6X5A - T48.6X5S Adverse effect of antiasthmatics, initial encounter - Adverse effect of antiasthmatics, sequela
T48.905A - T48.905S Adverse effect of unspecified agents primarily acting on the respiratory system, initial encounter - Adverse effect of unspecified agents primarily acting on the respiratory system, sequela
T48.995A - T48.995S Adverse effect of other agents primarily acting on the respiratory system, initial encounter - Adverse effect of other agents primarily acting on the respiratory system, sequela
T49.0X5A - T49.0X5S Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter - Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela
T49.1X5A - T49.1X5S Adverse effect of antipruritics, initial encounter - Adverse effect of antipruritics, sequela
T49.2X5A - T49.2X5S Adverse effect of local astringents and local detergents, initial encounter - Adverse effect of local astringents and local detergents, sequela
T49.3X5A - T49.3X5S Adverse effect of emollients, demulcents and protectants, initial encounter - Adverse effect of emollients, demulcents and protectants, sequela
T49.4X5A - T49.4X5S Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, initial encounter - Adverse effect of keratolytics, keratoplastics, and other hair treatment drugs and preparations, sequela
T49.5X5A - T49.5X5S Adverse effect of ophthalmological drugs and preparations, initial encounter - Adverse effect of ophthalmological drugs and preparations, sequela
T49.6X5A - T49.6X5S Adverse effect of otorhinolaryngological drugs and preparations, initial encounter - Adverse effect of otorhinolaryngological drugs and preparations, sequela
T49.7X5A - T49.7X5S Adverse effect of dental drugs, topically applied, initial encounter - Adverse effect of dental drugs, topically applied, sequela
T49.8X5A - T49.8X5S Adverse effect of other topical agents, initial encounter - Adverse effect of other topical agents, sequela
T49.95XA - T49.95XS Adverse effect of unspecified topical agent, initial encounter - Adverse effect of unspecified topical agent, sequela
T50.0X5A - T50.0X5S Adverse effect of mineralocorticoids and their antagonists, initial encounter - Adverse effect of mineralocorticoids and their antagonists, sequela
T50.1X5A - T50.1X5S Adverse effect of loop [high-ceiling] diuretics, initial encounter - Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X5A - T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter - Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X5A - T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, initial encounter - Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X5A - T50.4X5S Adverse effect of drugs affecting uric acid metabolism, initial encounter - Adverse effect of drugs affecting uric acid metabolism, sequela
T50.5X5A - T50.5X5S Adverse effect of appetite depressants, initial encounter - Adverse effect of appetite depressants, sequela
T50.6X5A - T50.6X5S Adverse effect of antidotes and chelating agents, initial encounter - Adverse effect of antidotes and chelating agents, sequela
T50.7X5A - T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, initial encounter - Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.8X5A - T50.8X5S Adverse effect of diagnostic agents, initial encounter - Adverse effect of diagnostic agents, sequela
T50.A15A - T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter - Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A25A - T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter - Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A95A - T50.A95S Adverse effect of other bacterial vaccines, initial encounter - Adverse effect of other bacterial vaccines, sequela
T50.B15A - T50.B15S Adverse effect of smallpox vaccines, initial encounter - Adverse effect of smallpox vaccines, sequela
T50.B95A - T50.B95S Adverse effect of other viral vaccines, initial encounter - Adverse effect of other viral vaccines, sequela
T50.Z15A - T50.Z15S Adverse effect of immunoglobulin, initial encounter - Adverse effect of immunoglobulin, sequela
T50.Z95A - T50.Z95S Adverse effect of other vaccines and biological substances, initial encounter - Adverse effect of other vaccines and biological substances, sequela
T50.905A - T50.905S Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter - Adverse effect of unspecified drugs, medicaments and biological substances, sequela
T50.995A - T50.995S Adverse effect of other drugs, medicaments and biological substances, initial encounter - Adverse effect of other drugs, medicaments and biological substances, sequela
T63.011A - T63.044S Toxic effect of rattlesnake venom, accidental (unintentional), initial encounter - Toxic effect of cobra venom, undetermined, sequela
T63.061A - T63.094S Toxic effect of venom of other North and South American snake, accidental (unintentional), initial encounter - Toxic effect of venom of other snake, undetermined, sequela
T63.111A - T63.124S Toxic effect of venom of gila monster, accidental (unintentional), initial encounter - Toxic effect of venom of other venomous lizard, undetermined, sequela
T63.191A - T63.194S Toxic effect of venom of other reptiles, accidental (unintentional), initial encounter - Toxic effect of venom of other reptiles, undetermined, sequela
T63.2X1A - T63.2X4S Toxic effect of venom of scorpion, accidental (unintentional), initial encounter - Toxic effect of venom of scorpion, undetermined, sequela
T63.311A - T63.334S Toxic effect of venom of black widow spider, accidental (unintentional), initial encounter - Toxic effect of venom of brown recluse spider, undetermined, sequela
T63.391A - T63.394S Toxic effect of venom of other spider, accidental (unintentional), initial encounter - Toxic effect of venom of other spider, undetermined, sequela
T63.411A - T63.484S Toxic effect of venom of centipedes and venomous millipedes, accidental (unintentional), initial encounter - Toxic effect of venom of other arthropod, undetermined, sequela
T63.511A - T63.514S Toxic effect of contact with stingray, accidental (unintentional), initial encounter - Toxic effect of contact with stingray, undetermined, sequela
T63.591A - T63.594S Toxic effect of contact with other venomous fish, accidental (unintentional), initial encounter - Toxic effect of contact with other venomous fish, undetermined, sequela
T63.611A - T63.634S Toxic effect of contact with Portuguese Man-o-war, accidental (unintentional), initial encounter - Toxic effect of contact with sea anemone, undetermined, sequela
T63.691A - T63.694S Toxic effect of contact with other venomous marine animals, accidental (unintentional), initial encounter - Toxic effect of contact with other venomous marine animals, undetermined, sequela
T63.711A - T63.714S Toxic effect of contact with venomous marine plant, accidental (unintentional), initial encounter - Toxic effect of contact with venomous marine plant, undetermined, sequela
T63.791A - T63.794S Toxic effect of contact with other venomous plant, accidental (unintentional), initial encounter - Toxic effect of contact with other venomous plant, undetermined, sequela
T63.811A - T63.834S Toxic effect of contact with venomous frog, accidental (unintentional), initial encounter - Toxic effect of contact with other venomous amphibian, undetermined, sequela
T63.891A - T63.894S Toxic effect of contact with other venomous animals, accidental (unintentional), initial encounter - Toxic effect of contact with other venomous animals, undetermined, sequela
T78.00XA - T78.00XS Anaphylactic reaction due to unspecified food, initial encounter - Anaphylactic reaction due to unspecified food, sequela
T78.01XA - T78.09XS Anaphylactic reaction due to peanuts, initial encounter - Anaphylactic reaction due to other food products, sequela
T78.2XXA - T78.3XXS Anaphylactic shock, unspecified, initial encounter - Angioneurotic edema, sequela
T78.40XA - T78.40XS Allergy, unspecified, initial encounter - Allergy, unspecified, sequela
T78.49XA - T78.49XS Other allergy, initial encounter - Other allergy, sequela
T88.6XXA - T88.6XXS Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, initial encounter - Anaphylactic reaction due to adverse effect of correct drug or medicament properly administered, sequela
Z91.048 Other nonmedicinal substance allergy status
Z91.09 Other allergy status, other than to drugs and biological substances
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2021 R2

Based on the annual ICD-10 updates for 2022, T40.7X5A, T40.7X5D, and T40.7X5S were deleted from ICD-10 Codes that Support Medical Necessity and replaced with T40.715A, T40.715D, and T40.715S. Descriptors were changed for the following codes: T63.611A, T63.611D, T63.611S, T63.612A, T63.612D, T63.612S, T63.613A, T63.613D, T63.613S, T63.614A, T63.614D, and T63.614S.
10/01/2020 R1

Based on the annual ICD-10 updates for 2021, T40.4X5A, T40.4X5D and T40.4X5S were deleted from ICD-10 Codes that Support Medical Necessity and replaced by T40.495A, T40.495D and T40.495S.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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LCDs
L33591 - RAST Type Tests
Related National Coverage Documents
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SAD Process URL 2
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