Updates to Allergy Testing and Immunotherapy Medical Policy

Harvard Pilgrim has updated our commercial Allergy Testing and Immunotherapy Medical Policy, effective for dates of service beginning Sept. 1, 2021. As a result, allergy immunotherapy/rapid desensitization is considered medically necessary for individuals with allergies to venom or inhalants, allergic rhinitis, allergic conjunctivitis, and allergic asthma — in addition to the other indications identified on the policy.

In addition, the following ICD-10 diagnosis codes will be covered when billed in conjunction with CPT code 95180 (Rapid desensitization procedure, each hour [e.g., insulin, penicillin, equine serum]):

  • H10411 – Chronic giant papillary conjunctivitis, right eye
  • H10412 – Chronic giant papillary conjunctivitis, left eye
  • H10413 – Chronic giant papillary conjunctivitis, bilateral
  • H1045 – Other chronic allergic conjunctivitis
  • J300 – Vasomotor rhinitis
  • J301 – Allergic rhinitis due to pollen
  • J302 – Other seasonal allergic rhinitis
  • J305 – Allergic rhinitis due to food
  • J3081 – Allergic rhinitis due to animal (cat) (dog) hair and dander
  • J3089 – Other allergic rhinitis
  • J309 – Allergic rhinitis, unspecified
  • J4520 – Mild intermittent asthma, uncomplicated
  • J4521 – Mild intermittent asthma with (acute) exacerbation
  • J4522 – Mild intermittent asthma with status asthmaticus
  • J4530 – Mild persistent asthma, uncomplicated
  • J4531 – Mild persistent asthma with (acute) exacerbation
  • J4532 – Mild persistent asthma with status asthmaticus
  • J4540 – Moderate persistent asthma, uncomplicated
  • J4541 – Moderate persistent asthma with (acute) exacerbation
  • J4542 – Moderate persistent asthma with status asthmaticus
  • J4550 – Severe persistent asthma, uncomplicated
  • J4551 – Severe persistent asthma with (acute) exacerbation
  • J4552 – Severe persistent asthma with status asthmaticus
  • J45909 – Unspecified asthma, uncomplicated
  • J45998 – Other asthma

For complete information, please refer to the updated Allergy Testing and Immunotherapy Medical Policy.

Publication Information

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator