Allergy Testing - Patch Test and Photo Patch Test
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 ONE of the following conditions:
Delayed hypersensitivity to skin contact allergens
Causative allergens for contact eczematous dermatitis
Chronic occupational dermatitis
Allergic contact dermatitis
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2005). Allergy testing (2.01.23). Retrieved July 23, 2003 from BlueWeb.
Hayes Medical Technology Directory. (1999, April). Allergy Testing, In Vivo (ALLE0403.06). Retrieved July 23, 2003 from Hayes Inc Online.
ORIGINAL EFFECTIVE DATE: 10/12/1998
MOST RECENT REVIEW DATE: 9/25/2008
ID_BT
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.
This document has been classified as public information.