DESCRIPTION
Patch test
This testing modality, also known as application test, identifies allergens causing contact dermatitis. The suspected allergens are applied to the individual's back under dressings and allowed to remain in contact with the skin for 48 hours. The area is then examined for evidence of delayed hypersensitivity reactions, and may be observed again 1 to 5 days after the first reading.
Photo patch test
This test reflects contact photosensitization. If an area of skin has been applied with a suspected sensitizer for 48 hours and no reaction occurs, the area is exposed to a dose of ultraviolet light sufficient to produce inflammatory redness. If the test is positive, a more severe reaction develops at the patch site than on surrounding skin.
POLICY
The patch test for the diagnosis of allergies is considered medically necessary if the medical appropriateness criteria are met. (See the Medical Appropriateness below.)
The photo patch test for the diagnosis of allergies is considered medically necessary.
MEDICAL APPROPRIATENESS
The patch test to confirm or rule out the diagnosis of allergies is considered medically appropriate for any of the following conditions:
Delayed hypersensitivity to skin contact allergens; or
Causative allergens for contact eczematous dermatitis; or
Chronic occupational dermatitis; or
Allergic contact dermatitis.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (1996, November). Allergy testing (2.01.23). Retrieved July 23, 2003 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer software]. (2003, March). Food allergy testing and treatment - not covered (section 50-53, p. 1-72). St. Anthony Publishing.
Hayes Medical Technology Directory. (1999, April). Allergy Testing, In Vivo (ALLE0403.06). Retrieved July 23, 2003 from Hayes Inc Online.
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EFFECTIVE DATE |
9/11/2003 |
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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