Billing and Coding: Allergy Testing (A56558)


Related Local Coverage Determination (LCD)
L36241-Allergy Testing


Contractor NameContract NumberStates
Novitas Solutions, Inc. 04111 - A and B MAC Colorado
04112 - A and B MAC Colorado
04211 - A and B MAC New Mexico
04212 - A and B MAC New Mexico
04311 - A and B MAC Oklahoma
04312 - A and B MAC Oklahoma
04411 - A and B MAC Texas
04412 - A and B MAC Texas
04911 - A and B MAC Colorado
New Mexico
Oklahoma
Texas
07101 - A and B MAC Arkansas
07102 - A and B MAC Arkansas
07201 - A and B MAC Louisiana
07202 - A and B MAC Louisiana
07301 - A and B MAC Mississippi
07302 - A and B MAC Mississippi
12101 - A and B MAC Delaware
12102 - A and B MAC Delaware
12201 - A and B MAC District of Columbia
12202 - A and B MAC District of Columbia
12301 - A and B MAC Maryland
12302 - A and B MAC Maryland
12401 - A and B MAC New Jersey
12402 - A and B MAC New Jersey
12501 - A and B MAC Pennsylvania
12502 - A and B MAC Pennsylvania
12901 - A and B MAC Delaware
District of Columbia
Maryland
New Jersey
Pennsylvania

Article Information

Article ID Number: A56558 Status: A-Approved

Article Title: Billing and Coding: Allergy Testing

Original Article Effective Date: 05/16/2019

Revision Effective Date: 07/11/2021

Article Text:

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L36241, Allergy Testing. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice
: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Consistent with the related LCD, CPT code 82785 Gammaglobulin [immunoglobulin]; IgE is not appropriate in most general allergy testing. Please refer to the LCD for details on medically reasonable and necessary guidelines.

It is not usually necessary to report CPT code 86003 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract (in vitro testing) in addition to skin testing. Please see the related LCD for medically reasonable and necessary guidelines.

Documentation Requirements:

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The medical record must support the use of the selected ICD-10-CM code(s).
  4. The submitted CPT/HCPCS code must describe the service performed.
  5. Prior to performance of allergy testing, there must be evidence in the medical record that a history has been obtained, indicating the possible presence of allergy.
    • This history should support that attempts to narrow the area of investigation were taken so that the minimal number of necessary skin tests might deliver a diagnosis.
    • The history should support that the selection of antigens was based on the patient specific history and physician examination.
  1. The medical record must indicate which allergy test(s) were used, the interpretation(s), and measurement (in mm) of reaction size of both wheal and erythema response or a standardized grading system in vivo testing (as applicable).

Coding Information
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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

999Not Applicable

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

CPT/HCPCS Codes:

Group 1 Paragraph:

 

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.



Group 1 CPT Codes:
86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH
86008 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, RECOMBINANT OR PURIFIED COMPONENT, EACH
95004 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95017 ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS (SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS (INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH VENOMS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95018 ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS (SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS (INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH DRUGS OR BIOLOGICALS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95024 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95027 INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH ALLERGENIC EXTRACTS FOR AIRBORNE ALLERGENS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS
95028 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTION, INCLUDING READING, SPECIFY NUMBER OF TESTS


Group 2 Paragraph: N/A

Group 2 CPT Codes:
82785 GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE
86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH
86008 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, RECOMBINANT OR PURIFIED COMPONENT, EACH
95070 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WITH HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS


Group 3 Paragraph: N/A

Group 3 CPT Codes:
95044 PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)
95052 PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS)
95056 PHOTO TESTS
95060 OPHTHALMIC MUCOUS MEMBRANE TESTS
95065 DIRECT NASAL MUCOUS MEMBRANE TEST


Group 4 Paragraph: N/A

Group 4 CPT Codes:
95076 INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); INITIAL 120 MINUTES OF TESTING
95079 INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); EACH ADDITIONAL 60 MINUTES OF TESTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)


Group 5 Paragraph:

The following CPT codes are non-covered:



Group 5 CPT Codes:
86001 ALLERGEN SPECIFIC IGG QUANTITATIVE OR SEMIQUANTITATIVE, EACH ALLERGEN
86005 ALLERGEN SPECIFIC IGE; QUALITATIVE, MULTIALLERGEN SCREEN (EG, DISK, SPONGE, CARD)


ICD-10 Codes That Are Covered

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10 codes support medical necessity and provide coverage for CPT codes: 86003, 86008, 95004, 95017, 95018, 95024, 95027, and 95028.

H10.411 Chronic giant papillary conjunctivitis, right eye
H10.412 Chronic giant papillary conjunctivitis, left eye
H10.413 Chronic giant papillary conjunctivitis, bilateral
H10.44 Vernal conjunctivitis
H10.45 Other chronic allergic conjunctivitis
H65.411 Chronic allergic otitis media, right ear
H65.412 Chronic allergic otitis media, left ear
H65.413 Chronic allergic otitis media, bilateral
J30.1 Allergic rhinitis due to pollen
J30.2 Other seasonal allergic rhinitis
J30.81 Allergic rhinitis due to animal (cat) (dog) hair and dander
J30.89 Other allergic rhinitis
J31.0 Chronic rhinitis
J32.0 Chronic maxillary sinusitis
J32.1 Chronic frontal sinusitis
J32.2 Chronic ethmoidal sinusitis
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
J45.991 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
L27.2 Dermatitis due to ingested food
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5D Adverse effect of penicillins, subsequent encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5D Adverse effect of cephalosporins and other beta-lactam antibiotics, subsequent encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5D Adverse effect of tetracyclines, subsequent encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5D Adverse effect of other systemic antibiotics, subsequent encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5D Adverse effect of sulfonamides, subsequent encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.8X5A Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter
T37.8X5D Adverse effect of other specified systemic anti-infectives and antiparasitics, subsequent encounter
T37.8X5S Adverse effect of other specified systemic anti-infectives and antiparasitics, sequela
T39.015A Adverse effect of aspirin, initial encounter
T39.015D Adverse effect of aspirin, subsequent encounter
T39.015S Adverse effect of aspirin, sequela
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5D Adverse effect of 4-Aminophenol derivatives, subsequent encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5D Adverse effect of antiallergic and antiemetic drugs, subsequent encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T63.421A Toxic effect of venom of ants, accidental (unintentional), initial encounter
T63.421D Toxic effect of venom of ants, accidental (unintentional), subsequent encounter
T63.421S Toxic effect of venom of ants, accidental (unintentional), sequela
T63.422A Toxic effect of venom of ants, intentional self-harm, initial encounter
T63.422D Toxic effect of venom of ants, intentional self-harm, subsequent encounter
T63.422S Toxic effect of venom of ants, intentional self-harm, sequela
T63.423A Toxic effect of venom of ants, assault, initial encounter
T63.423D Toxic effect of venom of ants, assault, subsequent encounter
T63.423S Toxic effect of venom of ants, assault, sequela
T63.424A Toxic effect of venom of ants, undetermined, initial encounter
T63.424D Toxic effect of venom of ants, undetermined, subsequent encounter
T63.424S Toxic effect of venom of ants, undetermined, sequela
T63.431A Toxic effect of venom of caterpillars, accidental (unintentional), initial encounter
T63.431D Toxic effect of venom of caterpillars, accidental (unintentional), subsequent encounter
T63.431S Toxic effect of venom of caterpillars, accidental (unintentional), sequela
T63.432A Toxic effect of venom of caterpillars, intentional self-harm, initial encounter
T63.432D Toxic effect of venom of caterpillars, intentional self-harm, subsequent encounter
T63.432S Toxic effect of venom of caterpillars, intentional self-harm, sequela
T63.433A Toxic effect of venom of caterpillars, assault, initial encounter
T63.433D Toxic effect of venom of caterpillars, assault, subsequent encounter
T63.433S Toxic effect of venom of caterpillars, assault, sequela
T63.434A Toxic effect of venom of caterpillars, undetermined, initial encounter
T63.434D Toxic effect of venom of caterpillars, undetermined, subsequent encounter
T63.434S Toxic effect of venom of caterpillars, undetermined, sequela
T63.441A Toxic effect of venom of bees, accidental (unintentional), initial encounter
T63.441D Toxic effect of venom of bees, accidental (unintentional), subsequent encounter
T63.441S Toxic effect of venom of bees, accidental (unintentional), sequela
T63.442A Toxic effect of venom of bees, intentional self-harm, initial encounter
T63.442D Toxic effect of venom of bees, intentional self-harm, subsequent encounter
T63.442S Toxic effect of venom of bees, intentional self-harm, sequela
T63.443A Toxic effect of venom of bees, assault, initial encounter
T63.443D Toxic effect of venom of bees, assault, subsequent encounter
T63.443S Toxic effect of venom of bees, assault, sequela
T63.444A Toxic effect of venom of bees, undetermined, initial encounter
T63.444D Toxic effect of venom of bees, undetermined, subsequent encounter
T63.444S Toxic effect of venom of bees, undetermined, sequela
T63.451A Toxic effect of venom of hornets, accidental (unintentional), initial encounter
T63.451D Toxic effect of venom of hornets, accidental (unintentional), subsequent encounter
T63.451S Toxic effect of venom of hornets, accidental (unintentional), sequela
T63.452A Toxic effect of venom of hornets, intentional self-harm, initial encounter
T63.452D Toxic effect of venom of hornets, intentional self-harm, subsequent encounter
T63.452S Toxic effect of venom of hornets, intentional self-harm, sequela
T63.453A Toxic effect of venom of hornets, assault, initial encounter
T63.453D Toxic effect of venom of hornets, assault, subsequent encounter
T63.453S Toxic effect of venom of hornets, assault, sequela
T63.454A Toxic effect of venom of hornets, undetermined, initial encounter
T63.454D Toxic effect of venom of hornets, undetermined, subsequent encounter
T63.454S Toxic effect of venom of hornets, undetermined, sequela
T63.461A Toxic effect of venom of wasps, accidental (unintentional), initial encounter
T63.461D Toxic effect of venom of wasps, accidental (unintentional), subsequent encounter
T63.461S Toxic effect of venom of wasps, accidental (unintentional), sequela
T63.462A Toxic effect of venom of wasps, intentional self-harm, initial encounter
T63.462D Toxic effect of venom of wasps, intentional self-harm, subsequent encounter
T63.462S Toxic effect of venom of wasps, intentional self-harm, sequela
T63.463A Toxic effect of venom of wasps, assault, initial encounter
T63.463D Toxic effect of venom of wasps, assault, subsequent encounter
T63.463S Toxic effect of venom of wasps, assault, sequela
T63.464A Toxic effect of venom of wasps, undetermined, initial encounter
T63.464D Toxic effect of venom of wasps, undetermined, subsequent encounter
T63.464S Toxic effect of venom of wasps, undetermined, sequela
T63.481A Toxic effect of venom of other arthropod, accidental (unintentional), initial encounter
T63.481D Toxic effect of venom of other arthropod, accidental (unintentional), subsequent encounter
T63.481S Toxic effect of venom of other arthropod, accidental (unintentional), sequela
T63.482A Toxic effect of venom of other arthropod, intentional self-harm, initial encounter
T63.482D Toxic effect of venom of other arthropod, intentional self-harm, subsequent encounter
T63.482S Toxic effect of venom of other arthropod, intentional self-harm, sequela
T63.483A Toxic effect of venom of other arthropod, assault, initial encounter
T63.483D Toxic effect of venom of other arthropod, assault, subsequent encounter
T63.483S Toxic effect of venom of other arthropod, assault, sequela
T63.484A Toxic effect of venom of other arthropod, undetermined, initial encounter
T63.484D Toxic effect of venom of other arthropod, undetermined, subsequent encounter
T63.484S Toxic effect of venom of other arthropod, undetermined, sequela
T78.01XA Anaphylactic reaction due to peanuts, initial encounter
T78.01XD Anaphylactic reaction due to peanuts, subsequent encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XA Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.02XD Anaphylactic reaction due to shellfish (crustaceans), subsequent encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XA Anaphylactic reaction due to other fish, initial encounter
T78.03XD Anaphylactic reaction due to other fish, subsequent encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XA Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.04XD Anaphylactic reaction due to fruits and vegetables, subsequent encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XA Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.05XD Anaphylactic reaction due to tree nuts and seeds, subsequent encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XA Anaphylactic reaction due to food additives, initial encounter
T78.06XD Anaphylactic reaction due to food additives, subsequent encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XA Anaphylactic reaction due to milk and dairy products, initial encounter
T78.07XD Anaphylactic reaction due to milk and dairy products, subsequent encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XA Anaphylactic reaction due to eggs, initial encounter
T78.08XD Anaphylactic reaction due to eggs, subsequent encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XA Anaphylactic reaction due to other food products, initial encounter
T78.09XD Anaphylactic reaction due to other food products, subsequent encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.3XXA Angioneurotic edema, initial encounter
T78.3XXD Angioneurotic edema, subsequent encounter
T78.3XXS Angioneurotic edema, sequela
T78.49XA Other allergy, initial encounter
T78.49XD Other allergy, subsequent encounter
T78.49XS Other allergy, sequela
T80.51XA Anaphylactic reaction due to administration of blood and blood products, initial encounter
T80.51XD Anaphylactic reaction due to administration of blood and blood products, subsequent encounter
T80.51XS Anaphylactic reaction due to administration of blood and blood products, sequela
T80.52XA Anaphylactic reaction due to vaccination, initial encounter
T80.52XD Anaphylactic reaction due to vaccination, subsequent encounter
T80.52XS Anaphylactic reaction due to vaccination, sequela
T80.59XA Anaphylactic reaction due to other serum, initial encounter
T80.59XD Anaphylactic reaction due to other serum, subsequent encounter
T80.59XS Anaphylactic reaction due to other serum, sequela
T80.61XA Other serum reaction due to administration of blood and blood products, initial encounter
T80.61XD Other serum reaction due to administration of blood and blood products, subsequent encounter
T80.61XS Other serum reaction due to administration of blood and blood products, sequela
T80.62XA Other serum reaction due to vaccination, initial encounter
T80.62XD Other serum reaction due to vaccination, subsequent encounter
T80.62XS Other serum reaction due to vaccination, sequela
T80.69XA Other serum reaction due to other serum, initial encounter
T80.69XD Other serum reaction due to other serum, subsequent encounter
T80.69XS Other serum reaction due to other serum, sequela

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10 codes support medical necessity and provide coverage for CPT codes: 82785, 86003 (Specific IgE in-vitro Testing), 86008 and 95070.

B44.0 Invasive pulmonary aspergillosis
J31.0 Chronic rhinitis
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
J45.991 Cough variant asthma
J45.998 Other asthma
L20.82 Flexural eczema
L20.84 Intrinsic (allergic) eczema
L20.89 Other atopic dermatitis
L50.0 Allergic urticaria
L50.1 Idiopathic urticaria
L50.3 Dermatographic urticaria
L50.6 Contact urticaria
L50.8 Other urticaria
T63.91XA Toxic effect of contact with unspecified venomous animal, accidental (unintentional), initial encounter
T63.91XD Toxic effect of contact with unspecified venomous animal, accidental (unintentional), subsequent encounter
T63.91XS Toxic effect of contact with unspecified venomous animal, accidental (unintentional), sequela
T63.92XA Toxic effect of contact with unspecified venomous animal, intentional self-harm, initial encounter
T63.92XD Toxic effect of contact with unspecified venomous animal, intentional self-harm, subsequent encounter
T63.92XS Toxic effect of contact with unspecified venomous animal, intentional self-harm, sequela
T63.93XA Toxic effect of contact with unspecified venomous animal, assault, initial encounter
T63.93XD Toxic effect of contact with unspecified venomous animal, assault, subsequent encounter
T63.93XS Toxic effect of contact with unspecified venomous animal, assault, sequela
T63.94XA Toxic effect of contact with unspecified venomous animal, undetermined, initial encounter
T63.94XD Toxic effect of contact with unspecified venomous animal, undetermined, subsequent encounter
T63.94XS Toxic effect of contact with unspecified venomous animal, undetermined, sequela
T65.811A Toxic effect of latex, accidental (unintentional), initial encounter
T65.811D Toxic effect of latex, accidental (unintentional), subsequent encounter
T65.811S Toxic effect of latex, accidental (unintentional), sequela
T65.812A Toxic effect of latex, intentional self-harm, initial encounter
T65.812D Toxic effect of latex, intentional self-harm, subsequent encounter
T65.812S Toxic effect of latex, intentional self-harm, sequela
T65.813A Toxic effect of latex, assault, initial encounter
T65.813D Toxic effect of latex, assault, subsequent encounter
T65.813S Toxic effect of latex, assault, sequela
T65.814A Toxic effect of latex, undetermined, initial encounter
T65.814D Toxic effect of latex, undetermined, subsequent encounter
T65.814S Toxic effect of latex, undetermined, sequela
T78.01XA Anaphylactic reaction due to peanuts, initial encounter
T78.01XD Anaphylactic reaction due to peanuts, subsequent encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XA Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.02XD Anaphylactic reaction due to shellfish (crustaceans), subsequent encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XA Anaphylactic reaction due to other fish, initial encounter
T78.03XD Anaphylactic reaction due to other fish, subsequent encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XA Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.04XD Anaphylactic reaction due to fruits and vegetables, subsequent encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XA Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.05XD Anaphylactic reaction due to tree nuts and seeds, subsequent encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XA Anaphylactic reaction due to food additives, initial encounter
T78.06XD Anaphylactic reaction due to food additives, subsequent encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XA Anaphylactic reaction due to milk and dairy products, initial encounter
T78.07XD Anaphylactic reaction due to milk and dairy products, subsequent encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XA Anaphylactic reaction due to eggs, initial encounter
T78.08XD Anaphylactic reaction due to eggs, subsequent encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XA Anaphylactic reaction due to other food products, initial encounter
T78.09XD Anaphylactic reaction due to other food products, subsequent encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
Z86.19 Personal history of other infectious and parasitic diseases

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10 codes support medical necessity and provide coverage for CPT codes: 95044, 95052, 95056, 95060, and 95065.

L23.0 Allergic contact dermatitis due to metals
L23.1 Allergic contact dermatitis due to adhesives
L23.2 Allergic contact dermatitis due to cosmetics
L23.3 Allergic contact dermatitis due to drugs in contact with skin
L23.4 Allergic contact dermatitis due to dyes
L23.5 Allergic contact dermatitis due to other chemical products
L23.6 Allergic contact dermatitis due to food in contact with the skin
L23.7 Allergic contact dermatitis due to plants, except food
L23.81 Allergic contact dermatitis due to animal (cat) (dog) dander
L23.89 Allergic contact dermatitis due to other agents
L23.9 Allergic contact dermatitis, unspecified cause
L24.0 Irritant contact dermatitis due to detergents
L24.1 Irritant contact dermatitis due to oils and greases
L24.2 Irritant contact dermatitis due to solvents
L24.3 Irritant contact dermatitis due to cosmetics
L24.4 Irritant contact dermatitis due to drugs in contact with skin
L24.5 Irritant contact dermatitis due to other chemical products
L24.6 Irritant contact dermatitis due to food in contact with skin
L24.7 Irritant contact dermatitis due to plants, except food
L24.81 Irritant contact dermatitis due to metals
L24.89 Irritant contact dermatitis due to other agents
L24.9 Irritant contact dermatitis, unspecified cause
L25.0 Unspecified contact dermatitis due to cosmetics
L25.1 Unspecified contact dermatitis due to drugs in contact with skin
L25.2 Unspecified contact dermatitis due to dyes
L25.3 Unspecified contact dermatitis due to other chemical products
L25.4 Unspecified contact dermatitis due to food in contact with skin
L25.5 Unspecified contact dermatitis due to plants, except food
L25.8 Unspecified contact dermatitis due to other agents
L25.9 Unspecified contact dermatitis, unspecified cause
L30.8 Other specified dermatitis

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10 codes support medical necessity and provide coverage for CPT codes: 95076 and 95079 (Ingestion Challenge Testing).

L27.2 Dermatitis due to ingested food
T36.0X5A Adverse effect of penicillins, initial encounter
T36.0X5D Adverse effect of penicillins, subsequent encounter
T36.0X5S Adverse effect of penicillins, sequela
T36.1X5A Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter
T36.1X5D Adverse effect of cephalosporins and other beta-lactam antibiotics, subsequent encounter
T36.1X5S Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.2X5A Adverse effect of chloramphenicol group, initial encounter
T36.2X5D Adverse effect of chloramphenicol group, subsequent encounter
T36.2X5S Adverse effect of chloramphenicol group, sequela
T36.3X5A Adverse effect of macrolides, initial encounter
T36.3X5D Adverse effect of macrolides, subsequent encounter
T36.3X5S Adverse effect of macrolides, sequela
T36.4X5A Adverse effect of tetracyclines, initial encounter
T36.4X5D Adverse effect of tetracyclines, subsequent encounter
T36.4X5S Adverse effect of tetracyclines, sequela
T36.5X5A Adverse effect of aminoglycosides, initial encounter
T36.5X5D Adverse effect of aminoglycosides, subsequent encounter
T36.5X5S Adverse effect of aminoglycosides, sequela
T36.6X5A Adverse effect of rifampicins, initial encounter
T36.6X5D Adverse effect of rifampicins, subsequent encounter
T36.6X5S Adverse effect of rifampicins, sequela
T36.7X5A Adverse effect of antifungal antibiotics, systemically used, initial encounter
T36.7X5D Adverse effect of antifungal antibiotics, systemically used, subsequent encounter
T36.7X5S Adverse effect of antifungal antibiotics, systemically used, sequela
T36.8X5A Adverse effect of other systemic antibiotics, initial encounter
T36.8X5D Adverse effect of other systemic antibiotics, subsequent encounter
T36.8X5S Adverse effect of other systemic antibiotics, sequela
T37.0X5A Adverse effect of sulfonamides, initial encounter
T37.0X5D Adverse effect of sulfonamides, subsequent encounter
T37.0X5S Adverse effect of sulfonamides, sequela
T37.1X5A Adverse effect of antimycobacterial drugs, initial encounter
T37.1X5D Adverse effect of antimycobacterial drugs, subsequent encounter
T37.1X5S Adverse effect of antimycobacterial drugs, sequela
T37.2X5A Adverse effect of antimalarials and drugs acting on other blood protozoa, initial encounter
T37.2X5D Adverse effect of antimalarials and drugs acting on other blood protozoa, subsequent encounter
T37.2X5S Adverse effect of antimalarials and drugs acting on other blood protozoa, sequela
T37.3X5A Adverse effect of other antiprotozoal drugs, initial encounter
T37.3X5D Adverse effect of other antiprotozoal drugs, subsequent encounter
T37.3X5S Adverse effect of other antiprotozoal drugs, sequela
T37.4X5A Adverse effect of anthelminthics, initial encounter
T37.4X5D Adverse effect of anthelminthics, subsequent encounter
T37.4X5S Adverse effect of anthelminthics, sequela
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.5X5D Adverse effect of antiviral drugs, subsequent encounter
T37.5X5S Adverse effect of antiviral drugs, sequela
T37.8X5A Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter
T37.8X5D Adverse effect of other specified systemic anti-infectives and antiparasitics, subsequent encounter
T37.8X5S Adverse effect of other specified systemic anti-infectives and antiparasitics, sequela
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter
T38.1X5D Adverse effect of thyroid hormones and substitutes, subsequent encounter
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela
T38.2X5A Adverse effect of antithyroid drugs, initial encounter
T38.2X5D Adverse effect of antithyroid drugs, subsequent encounter
T38.2X5S Adverse effect of antithyroid drugs, sequela
T38.3X5A Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
T38.3X5D Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter
T38.3X5S Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela
T38.4X5A Adverse effect of oral contraceptives, initial encounter
T38.4X5D Adverse effect of oral contraceptives, subsequent encounter
T38.4X5S Adverse effect of oral contraceptives, sequela
T38.5X5A Adverse effect of other estrogens and progestogens, initial encounter
T38.5X5D Adverse effect of other estrogens and progestogens, subsequent encounter
T38.5X5S Adverse effect of other estrogens and progestogens, sequela
T38.6X5A Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter
T38.6X5D Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, subsequent encounter
T38.6X5S Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela
T38.7X5A Adverse effect of androgens and anabolic congeners, initial encounter
T38.7X5D Adverse effect of androgens and anabolic congeners, subsequent encounter
T38.7X5S Adverse effect of androgens and anabolic congeners, sequela
T38.815A Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter
T38.815D Adverse effect of anterior pituitary [adenohypophyseal] hormones, subsequent encounter
T38.815S Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela
T38.895A Adverse effect of other hormones and synthetic substitutes, initial encounter
T38.895D Adverse effect of other hormones and synthetic substitutes, subsequent encounter
T38.895S Adverse effect of other hormones and synthetic substitutes, sequela
T38.995A Adverse effect of other hormone antagonists, initial encounter
T38.995D Adverse effect of other hormone antagonists, subsequent encounter
T38.995S Adverse effect of other hormone antagonists, sequela
T39.015A Adverse effect of aspirin, initial encounter
T39.015D Adverse effect of aspirin, subsequent encounter
T39.015S Adverse effect of aspirin, sequela
T39.095A Adverse effect of salicylates, initial encounter
T39.095D Adverse effect of salicylates, subsequent encounter
T39.095S Adverse effect of salicylates, sequela
T39.1X5A Adverse effect of 4-Aminophenol derivatives, initial encounter
T39.1X5D Adverse effect of 4-Aminophenol derivatives, subsequent encounter
T39.1X5S Adverse effect of 4-Aminophenol derivatives, sequela
T39.2X5A Adverse effect of pyrazolone derivatives, initial encounter
T39.2X5D Adverse effect of pyrazolone derivatives, subsequent encounter
T39.2X5S Adverse effect of pyrazolone derivatives, sequela
T39.315A Adverse effect of propionic acid derivatives, initial encounter
T39.315D Adverse effect of propionic acid derivatives, subsequent encounter
T39.315S Adverse effect of propionic acid derivatives, sequela
T39.395A Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], initial encounter
T39.395D Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], subsequent encounter
T39.395S Adverse effect of other nonsteroidal anti-inflammatory drugs [NSAID], sequela
T39.4X5A Adverse effect of antirheumatics, not elsewhere classified, initial encounter
T39.4X5D Adverse effect of antirheumatics, not elsewhere classified, subsequent encounter
T39.4X5S Adverse effect of antirheumatics, not elsewhere classified, sequela
T39.8X5A Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, initial encounter
T39.8X5D Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, subsequent encounter
T39.8X5S Adverse effect of other nonopioid analgesics and antipyretics, not elsewhere classified, sequela
T44.3X5A Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, initial encounter
T44.3X5D Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, subsequent encounter
T44.3X5S Adverse effect of other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, sequela
T44.4X5A Adverse effect of predominantly alpha-adrenoreceptor agonists, initial encounter
T44.4X5D Adverse effect of predominantly alpha-adrenoreceptor agonists, subsequent encounter
T44.4X5S Adverse effect of predominantly alpha-adrenoreceptor agonists, sequela
T44.5X5A Adverse effect of predominantly beta-adrenoreceptor agonists, initial encounter
T44.5X5D Adverse effect of predominantly beta-adrenoreceptor agonists, subsequent encounter
T44.5X5S Adverse effect of predominantly beta-adrenoreceptor agonists, sequela
T44.6X5A Adverse effect of alpha-adrenoreceptor antagonists, initial encounter
T44.6X5D Adverse effect of alpha-adrenoreceptor antagonists, subsequent encounter
T44.6X5S Adverse effect of alpha-adrenoreceptor antagonists, sequela
T44.7X5A Adverse effect of beta-adrenoreceptor antagonists, initial encounter
T44.7X5D Adverse effect of beta-adrenoreceptor antagonists, subsequent encounter
T44.7X5S Adverse effect of beta-adrenoreceptor antagonists, sequela
T44.8X5A Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, initial encounter
T44.8X5D Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, subsequent encounter
T44.8X5S Adverse effect of centrally-acting and adrenergic-neuron-blocking agents, sequela
T44.995A Adverse effect of other drug primarily affecting the autonomic nervous system, initial encounter
T44.995D Adverse effect of other drug primarily affecting the autonomic nervous system, subsequent encounter
T44.995S Adverse effect of other drug primarily affecting the autonomic nervous system, sequela
T45.0X5A Adverse effect of antiallergic and antiemetic drugs, initial encounter
T45.0X5D Adverse effect of antiallergic and antiemetic drugs, subsequent encounter
T45.0X5S Adverse effect of antiallergic and antiemetic drugs, sequela
T45.1X5A Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter
T45.1X5D Adverse effect of antineoplastic and immunosuppressive drugs, subsequent encounter
T45.1X5S Adverse effect of antineoplastic and immunosuppressive drugs, sequela
T45.2X5A Adverse effect of vitamins, initial encounter
T45.2X5D Adverse effect of vitamins, subsequent encounter
T45.2X5S Adverse effect of vitamins, sequela
T45.3X5A Adverse effect of enzymes, initial encounter
T45.3X5D Adverse effect of enzymes, subsequent encounter
T45.3X5S Adverse effect of enzymes, sequela
T45.4X5A Adverse effect of iron and its compounds, initial encounter
T45.4X5D Adverse effect of iron and its compounds, subsequent encounter
T45.4X5S Adverse effect of iron and its compounds, sequela
T45.515A Adverse effect of anticoagulants, initial encounter
T45.515D Adverse effect of anticoagulants, subsequent encounter
T45.515S Adverse effect of anticoagulants, sequela
T45.525A Adverse effect of antithrombotic drugs, initial encounter
T45.525D Adverse effect of antithrombotic drugs, subsequent encounter
T45.525S Adverse effect of antithrombotic drugs, sequela
T45.615A Adverse effect of thrombolytic drugs, initial encounter
T45.615D Adverse effect of thrombolytic drugs, subsequent encounter
T45.615S Adverse effect of thrombolytic drugs, sequela
T45.625A Adverse effect of hemostatic drug, initial encounter
T45.625D Adverse effect of hemostatic drug, subsequent encounter
T45.625S Adverse effect of hemostatic drug, sequela
T45.695A Adverse effect of other fibrinolysis-affecting drugs, initial encounter
T45.695D Adverse effect of other fibrinolysis-affecting drugs, subsequent encounter
T45.695S Adverse effect of other fibrinolysis-affecting drugs, sequela
T45.7X5A Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, initial encounter
T45.7X5D Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, subsequent encounter
T45.7X5S Adverse effect of anticoagulant antagonists, vitamin K and other coagulants, sequela
T45.8X5A Adverse effect of other primarily systemic and hematological agents, initial encounter
T45.8X5D Adverse effect of other primarily systemic and hematological agents, subsequent encounter
T45.8X5S Adverse effect of other primarily systemic and hematological agents, sequela
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5D Adverse effect of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5D Adverse effect of calcium-channel blockers, subsequent encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5D Adverse effect of other antidysrhythmic drugs, subsequent encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.3X5A Adverse effect of coronary vasodilators, initial encounter
T46.3X5D Adverse effect of coronary vasodilators, subsequent encounter
T46.3X5S Adverse effect of coronary vasodilators, sequela
T46.4X5A Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter
T46.4X5D Adverse effect of angiotensin-converting-enzyme inhibitors, subsequent encounter
T46.4X5S Adverse effect of angiotensin-converting-enzyme inhibitors, sequela
T46.5X5A Adverse effect of other antihypertensive drugs, initial encounter
T46.5X5D Adverse effect of other antihypertensive drugs, subsequent encounter
T46.5X5S Adverse effect of other antihypertensive drugs, sequela
T46.6X5A Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter
T46.6X5D Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter
T46.6X5S Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela
T46.7X5A Adverse effect of peripheral vasodilators, initial encounter
T46.7X5D Adverse effect of peripheral vasodilators, subsequent encounter
T46.7X5S Adverse effect of peripheral vasodilators, sequela
T46.8X5A Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter
T46.8X5D Adverse effect of antivaricose drugs, including sclerosing agents, subsequent encounter
T46.8X5S Adverse effect of antivaricose drugs, including sclerosing agents, sequela
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995D Adverse effect of other agents primarily affecting the cardiovascular system, subsequent encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
T47.0X5A Adverse effect of histamine H2-receptor blockers, initial encounter
T47.0X5D Adverse effect of histamine H2-receptor blockers, subsequent encounter
T47.0X5S Adverse effect of histamine H2-receptor blockers, sequela
T47.1X5A Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter
T47.1X5D Adverse effect of other antacids and anti-gastric-secretion drugs, subsequent encounter
T47.1X5S Adverse effect of other antacids and anti-gastric-secretion drugs, sequela
T47.2X5A Adverse effect of stimulant laxatives, initial encounter
T47.2X5D Adverse effect of stimulant laxatives, subsequent encounter
T47.2X5S Adverse effect of stimulant laxatives, sequela
T47.3X5A Adverse effect of saline and osmotic laxatives, initial encounter
T47.3X5D Adverse effect of saline and osmotic laxatives, subsequent encounter
T47.3X5S Adverse effect of saline and osmotic laxatives, sequela
T47.4X5A Adverse effect of other laxatives, initial encounter
T47.4X5D Adverse effect of other laxatives, subsequent encounter
T47.4X5S Adverse effect of other laxatives, sequela
T47.5X5A Adverse effect of digestants, initial encounter
T47.5X5D Adverse effect of digestants, subsequent encounter
T47.5X5S Adverse effect of digestants, sequela
T47.6X5A Adverse effect of antidiarrheal drugs, initial encounter
T47.6X5D Adverse effect of antidiarrheal drugs, subsequent encounter
T47.6X5S Adverse effect of antidiarrheal drugs, sequela
T47.7X5A Adverse effect of emetics, initial encounter
T47.7X5D Adverse effect of emetics, subsequent encounter
T47.7X5S Adverse effect of emetics, sequela
T47.8X5A Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter
T47.8X5D Adverse effect of other agents primarily affecting gastrointestinal system, subsequent encounter
T47.8X5S Adverse effect of other agents primarily affecting gastrointestinal system, sequela
T48.0X5A Adverse effect of oxytocic drugs, initial encounter
T48.0X5D Adverse effect of oxytocic drugs, subsequent encounter
T48.0X5S Adverse effect of oxytocic drugs, sequela
T48.1X5A Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter
T48.1X5D Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], subsequent encounter
T48.1X5S Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela
T48.295A Adverse effect of other drugs acting on muscles, initial encounter
T48.295D Adverse effect of other drugs acting on muscles, subsequent encounter
T48.295S Adverse effect of other drugs acting on muscles, sequela
T48.3X5A Adverse effect of antitussives, initial encounter
T48.3X5D Adverse effect of antitussives, subsequent encounter
T48.3X5S Adverse effect of antitussives, sequela
T48.4X5A Adverse effect of expectorants, initial encounter
T48.4X5D Adverse effect of expectorants, subsequent encounter
T48.4X5S Adverse effect of expectorants, sequela
T48.5X5A Adverse effect of other anti-common-cold drugs, initial encounter
T48.5X5D Adverse effect of other anti-common-cold drugs, subsequent encounter
T48.5X5S Adverse effect of other anti-common-cold drugs, sequela
T48.6X5A Adverse effect of antiasthmatics, initial encounter
T48.6X5D Adverse effect of antiasthmatics, subsequent encounter
T48.6X5S Adverse effect of antiasthmatics, sequela
T48.995A Adverse effect of other agents primarily acting on the respiratory system, initial encounter
T48.995D Adverse effect of other agents primarily acting on the respiratory system, subsequent encounter
T48.995S Adverse effect of other agents primarily acting on the respiratory system, sequela
T49.5X5A Adverse effect of ophthalmological drugs and preparations, initial encounter
T49.5X5D Adverse effect of ophthalmological drugs and preparations, subsequent encounter
T49.5X5S Adverse effect of ophthalmological drugs and preparations, sequela
T50.0X5A Adverse effect of mineralocorticoids and their antagonists, initial encounter
T50.0X5D Adverse effect of mineralocorticoids and their antagonists, subsequent encounter
T50.0X5S Adverse effect of mineralocorticoids and their antagonists, sequela
T50.1X5A Adverse effect of loop [high-ceiling] diuretics, initial encounter
T50.1X5D Adverse effect of loop [high-ceiling] diuretics, subsequent encounter
T50.1X5S Adverse effect of loop [high-ceiling] diuretics, sequela
T50.2X5A Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter
T50.2X5D Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, subsequent encounter
T50.2X5S Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, sequela
T50.3X5A Adverse effect of electrolytic, caloric and water-balance agents, initial encounter
T50.3X5D Adverse effect of electrolytic, caloric and water-balance agents, subsequent encounter
T50.3X5S Adverse effect of electrolytic, caloric and water-balance agents, sequela
T50.4X5A Adverse effect of drugs affecting uric acid metabolism, initial encounter
T50.4X5D Adverse effect of drugs affecting uric acid metabolism, subsequent encounter
T50.4X5S Adverse effect of drugs affecting uric acid metabolism, sequela
T50.5X5A Adverse effect of appetite depressants, initial encounter
T50.5X5D Adverse effect of appetite depressants, subsequent encounter
T50.5X5S Adverse effect of appetite depressants, sequela
T50.7X5A Adverse effect of analeptics and opioid receptor antagonists, initial encounter
T50.7X5D Adverse effect of analeptics and opioid receptor antagonists, subsequent encounter
T50.7X5S Adverse effect of analeptics and opioid receptor antagonists, sequela
T50.8X5A Adverse effect of diagnostic agents, initial encounter
T50.8X5D Adverse effect of diagnostic agents, subsequent encounter
T50.8X5S Adverse effect of diagnostic agents, sequela
T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995D Adverse effect of other drugs, medicaments and biological substances, subsequent encounter
T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela
T50.A15A Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter
T50.A15D Adverse effect of pertussis vaccine, including combinations with a pertussis component, subsequent encounter
T50.A15S Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela
T50.A25A Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter
T50.A25D Adverse effect of mixed bacterial vaccines without a pertussis component, subsequent encounter
T50.A25S Adverse effect of mixed bacterial vaccines without a pertussis component, sequela
T50.A95A Adverse effect of other bacterial vaccines, initial encounter
T50.A95D Adverse effect of other bacterial vaccines, subsequent encounter
T50.A95S Adverse effect of other bacterial vaccines, sequela
T50.B95A Adverse effect of other viral vaccines, initial encounter
T50.B95D Adverse effect of other viral vaccines, subsequent encounter
T50.B95S Adverse effect of other viral vaccines, sequela
T50.Z15A Adverse effect of immunoglobulin, initial encounter
T50.Z15D Adverse effect of immunoglobulin, subsequent encounter
T50.Z15S Adverse effect of immunoglobulin, sequela
T50.Z95A Adverse effect of other vaccines and biological substances, initial encounter
T50.Z95D Adverse effect of other vaccines and biological substances, subsequent encounter
T50.Z95S Adverse effect of other vaccines and biological substances, sequela
T78.01XA Anaphylactic reaction due to peanuts, initial encounter
T78.01XD Anaphylactic reaction due to peanuts, subsequent encounter
T78.01XS Anaphylactic reaction due to peanuts, sequela
T78.02XA Anaphylactic reaction due to shellfish (crustaceans), initial encounter
T78.02XD Anaphylactic reaction due to shellfish (crustaceans), subsequent encounter
T78.02XS Anaphylactic reaction due to shellfish (crustaceans), sequela
T78.03XA Anaphylactic reaction due to other fish, initial encounter
T78.03XD Anaphylactic reaction due to other fish, subsequent encounter
T78.03XS Anaphylactic reaction due to other fish, sequela
T78.04XA Anaphylactic reaction due to fruits and vegetables, initial encounter
T78.04XD Anaphylactic reaction due to fruits and vegetables, subsequent encounter
T78.04XS Anaphylactic reaction due to fruits and vegetables, sequela
T78.05XA Anaphylactic reaction due to tree nuts and seeds, initial encounter
T78.05XD Anaphylactic reaction due to tree nuts and seeds, subsequent encounter
T78.05XS Anaphylactic reaction due to tree nuts and seeds, sequela
T78.06XA Anaphylactic reaction due to food additives, initial encounter
T78.06XD Anaphylactic reaction due to food additives, subsequent encounter
T78.06XS Anaphylactic reaction due to food additives, sequela
T78.07XA Anaphylactic reaction due to milk and dairy products, initial encounter
T78.07XD Anaphylactic reaction due to milk and dairy products, subsequent encounter
T78.07XS Anaphylactic reaction due to milk and dairy products, sequela
T78.08XA Anaphylactic reaction due to eggs, initial encounter
T78.08XD Anaphylactic reaction due to eggs, subsequent encounter
T78.08XS Anaphylactic reaction due to eggs, sequela
T78.09XA Anaphylactic reaction due to other food products, initial encounter
T78.09XD Anaphylactic reaction due to other food products, subsequent encounter
T78.09XS Anaphylactic reaction due to other food products, sequela
T78.1XXA Other adverse food reactions, not elsewhere classified, initial encounter
T78.1XXD Other adverse food reactions, not elsewhere classified, subsequent encounter
T78.1XXS Other adverse food reactions, not elsewhere classified, sequela
Z88.0 Allergy status to penicillin
Z88.1 Allergy status to other antibiotic agents
Z88.2 Allergy status to sulfonamides
Z88.3 Allergy status to other anti-infective agents
Z88.4 Allergy status to anesthetic agent
Z88.5 Allergy status to narcotic agent
Z88.6 Allergy status to analgesic agent
Z88.7 Allergy status to serum and vaccine
Z88.8 Allergy status to other drugs, medicaments and biological substances
Z91.010 Allergy to peanuts
Z91.011 Allergy to milk products
Z91.012 Allergy to eggs
Z91.013 Allergy to seafood
Z91.014 Allergy to mammalian meats
Z91.018 Allergy to other foods
ICD-10 Codes That Are Not Covered

XX000


Revision History Information
Revision History DateRevision History NumberRevision History Explanation
07/11/2021
R8

Article revised and published on 11/18/2021 effective for dates of service on and after 07/11/2021 in response to an inquiry. The following ICD-10-CM codes have been added to the ‘ICD-10-CM Codes that Support Medical Necessity’ section for ‘Group 4 Codes’: T36.0X5A, T36.0X5D, T36.0X5S, T36.1X5A, T36.1X5D, T36.1X5S, T36.2X5A, T36.2X5D, T36.2X5S, T36.3X5A, T36.3X5D, T36.3X5S, T36.4X5A, T36.4X5D, T36.4X5S, T36.5X5A, T36.5X5D, T36.5X5S, T36.6X5A, T36.6X5D, T36.6X5S, T36.7X5A, T36.7X5D, T36.7X5S, T36.8X5A, T36.8X5D, T36.8X5S, T37.0X5A, T37.0X5D, T37.0X5S, T37.1X5A, T37.1X5D, T37.1X5S, T37.2X5A, T37.2X5D, T37.2X5S, T37.3X5A, T37.3X5D, T37.3X5S, T37.4X5A, T37.4X5D, T37.4X5S, T37.5X5A, T37.5X5D, T37.5X5S, T37.8X5A, T37.8X5D, T37.8X5S, T38.0X5A, T38.0X5D, T38.0X5S, T38.1X5A, T38.1X5D, T38.1X5S, T38.2X5A, T38.2X5D, T38.2X5S, T38.3X5A, T38.3X5D, T38.3X5S, T38.4X5A, T38.4X5D, T38.4X5S, T38.5X5A, T38.5X5D, T38.5X5S, T38.6X5A, T38.6X5D, T38.6X5S, T38.7X5A, T38.7X5D, T38.7X5S, T38.815A, T38.815D, T38.815S, T38.895A, T38.895D, T38.895S, T38.995A, T38.995D, T38.995S, T39.015A, T39.015D, T39.015S, T39.095A, T39.095D, T39.095S, T39.1X5A, T39.1X5D, T39.1X5S, T39.2X5A, T39.2X5D, T39.2X5S, T39.315A, T39.315D, T39.315S, T39.395A, T39.395D, T39.395S, T39.4X5A, T39.4X5D, T39.4X5S, T39.8X5A, T39.8X5D, T39.8X5S, T44.3X5A, T44.3X5D, T44.3X5S, T44.4X5A, T44.4X5D, T44.4X5S, T44.5X5A, T44.5X5D, T44.5X5S, T44.6X5A, T44.6X5D, T44.6X5S, T44.7X5A, T44.7X5D, T44.7X5S, T44.8X5A, T44.8X5D, T44.8X5S, T44.995A, T44.995D, T44.995S, T45.0X5A, T45.0X5D, T45.0X5S, T45.1X5A, T45.1X5D, T45.1X5S, T45.2X5A, T45.2X5D, T45.2X5S, T45.3X5A, T45.3X5D, T45.3X5S, T45.4X5A, T45.4X5D, T45.4X5S, T45.515A, T45.515D, T45.515S, T45.525A, T45.525D, T45.525S, T45.615A, T45.615D, T45.615S, T45.625A, T45.625D, T45.625S, T45.695A, T45.695D, T45.695S, T45.7X5A, T45.7X5D, T45.7X5S, T45.8X5A, T45.8X5D, T45.8X5S, T46.0X5A, T46.0X5D, T46.0X5S, T46.1X5A, T46.1X5D, T46.1X5S, T46.2X5A, T46.2X5D, T46.2X5S, T46.3X5A, T46.3X5D, T46.3X5S, T46.4X5A, T46.4X5D, T46.4X5S, T46.5X5A, T46.5X5D, T46.5X5S, T46.6X5A, T46.6X5D, T46.6X5S, T46.7X5A, T46.7X5D, T46.7X5S, T46.8X5A, T46.8X5D, T46.8X5S, T46.995A, T46.995D, T46.995S, T47.0X5A, T47.0X5D, T47.0X5S, T47.1X5A, T47.1X5D, T47.1X5S, T47.2X5A, T47.2X5D, T47.2X5S, T47.3X5A, T47.3X5D, T47.3X5S, T47.4X5A, T47.4X5D, T47.4X5S, T47.5X5A, T47.5X5D, T47.5X5S, T47.6X5A, T47.6X5D, T47.6X5S, T47.7X5A, T47.7X5D, T47.7X5S, T47.8X5A, T47.8X5D, T47.8X5S, T48.0X5A, T48.0X5D, T48.0X5S, T48.1X5A, T48.1X5D, T48.1X5S, T48.295A, T48.295D, T48.295S, T48.3X5A, T48.3X5D, T48.3X5S, T48.4X5A, T48.4X5D, T48.4X5S, T48.5X5A, T48.5X5D, T48.5X5S, T48.6X5A, T48.6X5D, T48.6X5S, T48.995A, T48.995D, T48.995S, T49.5X5A, T49.5X5D, T49.5X5S, T50.0X5A, T50.0X5D, T50.0X5S, T50.1X5A, T50.1X5D, T50.1X5S, T50.2X5A, T50.2X5D, T50.2X5S, T50.3X5A, T50.3X5D, T50.3X5S, T50.4X5A, T50.4X5D, T50.4X5S, T50.5X5A, T50.5X5D, T50.5X5S, T50.7X5A, T50.7X5D, T50.7X5S, T50.8X5A, T50.8X5D, T50.8X5S, T50.A15A, T50.A15D, T50.A15S, T50.A25A, T50.A25D, T50.A25S, T50.A95A, T50.A95D, T50.A95S, T50.B95A, T50.B95D, T50.B95S, T50.Z15A, T50.Z15D, T50.Z15S, T50.Z95A, T50.Z95D, T50.Z95S, T50.995A, T50.995D, T50.995S, T78.1XXA, T78.1XXD, and T78.1XXS.

07/11/2021
R7

Article revised and published on 10/21/2021 effective for dates of service on and after 07/11/2021 in response to an inquiry. The following ICD-10 codes have been added to the ‘ICD-10-CM Codes that Support Medical Necessity’ section for ‘Group 4 Codes’: Z88.0, Z88.1, Z88.2, Z88.3, Z88.4, Z88.5, Z88.6, Z88.7, Z88.8, Z91.010, Z91.011, Z91.012, Z91.013, Z91.014, and Z91.018.

07/11/2021
R6

Draft article posted on 01/14/2021. Article effective for dates of service on and after 07/11/2021.

10/01/2020
R5

Article revised and published on 10/01/2020 effective for dates of service on and after 10/01/2020 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code(s) have undergone a descriptor change: Z88.1, Z88.2, Z88.3, Z88.4, Z88.5, Z88.6, Z88.7, Z88.8, Z88.9 for Group 1 Codes and Z88.1, Z88.2, Z88.3, Z88.4, Z88.5, Z88.6, Z88.7, Z88.8 for Group 4 Codes. Minor formatting changes made through the coding section.

07/01/2020
R4

Article revised and published on 07/30/2020 effective for dates of service on and after 07/01/2020, CPT code 0178U has been added to CPT code group 1 and ICD-10 group 2 paragraph. In addition, under CPT/HCPCS codes, Group 1 Codes, 0165U has a descriptor change due to July HCPCS code updates.

07/01/2020
R3

Article revised and published on 06/25/2020 effective for dates of service on and after 07/01/2020, as a non-discretionary update to remove CPT code 86001 from Group 2 CPT codes group. Minor formatting changes have been made.

04/01/2020
R2

Article revised and published on 04/30/2020 effective for dates of service on and after 04/01/2020, consistent with CMS Change Request 11681. CPT code 0165U was added to code group 1 and to the ICD-10 group 2 paragraph. Formatting changes have also been made.

10/17/2019
R1

Article revised and published on 10/17/2019 effective for dates of service on and after 10/01/2019 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has undergone a descriptor change: J44.0. An asterisk has been added next to Z86.19 in ICD-10 Code Group 2 code table and the note regarding this code has been moved from the Group 2 paragraph to the asterisk explanation. Please note, system changes have been made to our articles in response to CMS Change Request 10901. The Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.