Local Coverage Determination (LCD)

RAST Type Tests

L33591

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Contractor Information

LCD Information

Document Information

LCD ID
L33591
LCD Title
RAST Type Tests
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 11/07/2019
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2020 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 © 2020 American Dental Association. All rights reserved.

Copyright © 2013 - 2021, the American Hospital Association, Chicago, Illinois. Reproduced by CMS 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. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862 (a)(1)(A)allows coverage and payment for only those services considered medically reasonable and necessary.

Section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous tests are in vitro techniques for determining whether a patient's serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient.

The multiple antigen simultaneous testing technique is similar to the RAST/FAST techniques in that it depends upon the existence of allergic antibodies in the blood of the patient being tested. With the multiple antigen simultaneous test system, several antigens may be used to test for specific IgE simultaneously.

ELISA (enzyme-linked immunosorbent assay) is another in vitro method of allergy testing for specific IgE antibodies against allergens. This method is also a variation of RAST.

Limitations:

The following tests are considered to be not medically necessary and will be denied.

  • ELISA/Act qualitative antibody testing
    This testing is used to determine in vitro reaction to various foods and relies on lymphocyte blastogenesis in response to certain food antigens.
  • LMRA (Lymphocyte Mitogen Response Assays) by ELISA/Act
  • IgG ELISA, indirect method
  • Qualitative multi-allergen screen
    This is a non-specific test that does not identify a specific antigen.
  • IgG and IgG subclass antibody tests for food allergy do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed.

 

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

General Information

Associated Information
N/A
Sources of Information
N/A
Bibliography

This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

Adkinson NF, Yunginger JW, Busse WW, et al Middleton’s Allergy: Principles and Practice, 6th ed.

American College of Asthma, Allergy & Immunology (ACAAI). Practice Parameters for Allergy Diagnostic Testing. 1998.

Bernstein LI, Li JT, Bernstein DI et al, Practice Parameters for Allergy Diagnostic Testing: An Updated Practice Parameter. March 2008;100:S1-S148.

Revision History Information

Revision History DateRevision History NumberRevision History ExplanationReasons for Change
11/07/2019 R5

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56844. There has been no change in coverage with this LCD revision.

  • Revisions Due To Code Removal
01/01/2018 R4

Based on the 2018 annual HCPCS update, CPT code 86008 has been added to the CPT/HCPCS section and to the Group 1 paragraph for ICD-10 Codes that support Medical Necessity and the descriptions for CPT codes 86003 and 86005 have been revised.

DATE (01/01/2018): At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

  • Revisions Due To CPT/HCPCS Code Changes
10/01/2015 R3 The ICD-10 range T78.01XA-T78.49XS has been broken out to remove ICD-10 codes T78.1XXA-T78.1XXS and T78.41XA-T78.41XS.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R2 The following ICD-10 codes have been added: T36.0X5A - T36.0X5S, T36.1X5A - T36.1X5S, T36.2X5A - T36.2X5S, T36.3X5A - T36.3X5S, T36.4X5A - T36.4X5S, T36.5X5A - T36.5X5S, T36.6X5A - T36.6X5S, T36.7X5A - T36.7X5S, T36.8X5A - T36.8X5S, T36.95XA - T36.95XS, T37.0X5A - T37.0X5S, T37.1X5A - T37.1X5S, T37.2X5A - T37.2X5S, T37.3X5A - T37.3X5S, T37.4X5A - T37.4X5S, T37.5X5A - T37.5X5S, T37.8X5A - T37.8X5S, T37.95XA - T37.95XS,T38.0X5A - T38.0X5S, T38.1X5A - T38.1X5S, T38.2X5A - T38.2X5S, T38.4X5A - T38.4X5S, T38.5X5A - T38.5X5S, T38.6X5A - T38.6X5S, T38.7X5A - T38.7X5S, T38.805A - T38.805S, T38.815A - T38.815S, T38.895A - T38.895S, T38.905A - T38.905S, T38.995A - T38.995S, T39.015A - T39.015S, T39.095A - T39.095S, T39.1X5A - T39.1X5S, T39.2X5A - T39.2X5S, T39.315A - T39.315S, T39.395A - T39.395S, T39.4X5A - T39.4X5S, T39.8X5A - T39.8X5S, T39.95XA - T39.95XS, T40.0X5A - T40.0X5S, T40.2X5A - T40.2X5S, T40.3X5A - T40.3X5S, T40.4X5A - T40.4X5S, T40.5X5A - T40.5X5S, T40.605A - T40.605S, T40.695A - T40.695S, T40.7X5A - T40.7X5S, T40.905A - T40.905S, T40.995A - T40.995S, T41.0X5A - T41.0X5S, T41.1X5A - T41.1X5S, T41.295A - T41.295S, T41.3X5A - T41.3X5S, T41.5X5A - T41.5X5S, T42.0X5A - T42.0X5S, T42.1X5A - T42.1X5S, T42.2X5A - T42.2X5S, T42.3X5A - T42.3X5S, T42.4X5A - T42.4X5S, T42.5X5A - T42.5X5S, T42.6X5A - T42.6X5S, T42.75XA - T42.75XS, T42.8X5A - T42.8X5S, T43.015A - T43.015S, T43.025A - T43.025S, T43.1X5A - T43.1X5S, T43.205A - T43.205S, T43.215A - T43.215S, T43.225A - T43.225S, T43.295A - T43.295S, T43.3X5A - T43.3X5S, T43.4X5A - T43.4X5S, T43.505A - T43.505S, T43.595A - T43.595S, T43.605A - T43.605S, T43.615A - T43.615S, T43.625A - T43.625S, T43.635A - T43.635S, T43.695A - T43.695S, T43.8X5A - T43.8X5S, T43.95XA - T43.95XS, T44.0X5A - T44.0X5S, T44.1X5A - T44.1X5S, T44.2X5A - T44.2X5S, T44.3X5A - T44.3X5S, T44.4X5A - T44.4X5S, T44.5X5A - T44.5X5S, T44.6X5A - T44.6X5S, T44.7X5A - T44.7X5S, T44.8X5A - T44.8X5S, T44.905A - T44.905S, T44.995A - T44.995S, T45.0X5A - T45.0X5S, T45.1X5A - T45.1X5S, T45.2X5A - T45.2X5S, T45.3X5A - T45.3X5S, T45.4X5A - T45.4X5S, T45.515A - T45.515S, T45.525A - T45.525S, T45.605A - T45.605S, T45.615A - T45.615S, T45.625A - T45.625S, T45.695A - T45.695S, T45.7X5A - T45.7X5S, T45.8X5A - T45.8X5S, T45.95XA - T45.95XS, T46.0X5A - T46.0X5S, T46.1X5A - T46.1X5S, T46.2X5A - T46.2X5S, T46.3X5A - T46.3X5S, T46.4X5A - T46.4X5S, T46.5X5A - T46.5X5S, T46.6X5A - T46.6X5S, T46.7X5A - T46.7X5S, T46.8X5A - T46.8X5S, T46.905A - T46.905S, T46.995A - T46.995S, T47.0X5A - T47.0X5S, T47.1X5A - T47.1X5S, T47.2X5A - T47.2X5S, T47.3X5A - T47.3X5S, T47.4X5A - T47.4X5S, T47.5X5A - T47.5X5S, T47.6X5A - T47.6X5S, T47.7X5A - T47.7X5S, T47.8X5A - T47.8X5S, T47.95XA - T47.95XS, T48.0X5A - T48.0X5S, T48.1X5A - T48.1X5S, T48.205A - T48.205S, T48.295A - T48.295S, T48.3X5A - T48.3X5S, T48.4X5A - T48.4X5S, T48.5X5A - T48.5X5S, T48.6X5A - T48.6X5S, T48.905A - T48.905S, T48.995A - T48.995S, T49.0X5A - T49.0X5S, T49.1X5A - T49.1X5S, T49.2X5A - T49.2X5S, T49.3X5A - T49.3X5S, T49.4X5A - T49.4X5S, T49.5X5A - T49.5X5S, T49.6X5A - T49.6X5S, T49.7X5A - T49.7X5S, T49.8X5A - T49.8X5S, T49.95XA - T49.95XS, T50.0X5A - T50.0X5S, T50.1X5A - T50.1X5S, T50.2X5A - T50.2X5S, T50.3X5A - T50.3X5S, T50.4X5A - T50.4X5S, T50.5X5A - T50.5X5S, T50.6X5A - T50.6X5S, T50.7X5A - T50.7X5S, T50.8X5A - T50.8X5S, T50.A15A - T50.A15S, T50.A25A - T50.A25S, T50.A95A - T50.A95S, T50.B15A - T50.B15S, T50.B95A - T50.B95S, T50.Z15A - T50.Z15S, T50.Z95A - T50.Z95S, T50.905A - T50.905S, T50.995A - T50.995S, T63.011A - T63.044S, T63.061A - T63.093S, T63.094D, T63.094S, T63.111A - T63.124S, T63.191A - T63.194S, T63.2X1A - T63.2X4S, T63.311A - T63.334S, T63.391A - T63.394S, T63.411A – T63.483S, T63.484D, T63.484S, T63.511A - T63.514S, T63.591A - T63.594S, T63.611A - T63.634S, T63.691A – T63.693S, T63.694D, T63.694S, T63.711A - T63.714S, T63.791A – T63.793S, T63.794D, T63.794S, T63.811A - T63.834S, T63.891A - T63.894S, T78.00XA - T78.00XS, T78.01XD, T78.01XS, T78.02XD, T78.02XS, T78.03XD, T78.03XS, T78.04XD, T78.04XS, T78.05XD, T78.05XS, T78.06XD, T78.06XS, T78.07XD, T78.07XS, T78.08XD, T78.08XS, T78.09XD, T78.09XS, T78.2XXD, T78.2XXS, T78.3XXD, T78.3XXS, T78.40XD, T78.40XS, T78.49XD, T78.49XS. T88.6XXA – T88.6XXS.
The following ICD-10 codes have been removed: T63.91XA - T63.94XA and T88.59XA.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R1 Add Bill type codes
  • Other

Associated Documents

Attachments
N/A
Related Local Coverage Documents
Articles
A56844 - Billing and Coding: RAST Type Tests
Related National Coverage Documents
N/A
Public Versions
Updated On Effective Dates Status
11/01/2019 11/07/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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