Effective February 1, 2022: Clinical Payment Policy Revision - Allergy Testing and Immunotherapy

Date: 11/01/21

Superior HealthPlan presents revised clinical payment policies to communicate the credentialing requirements for applicable non-Allergist/Immunologist specialties and allergy testing and immunotherapy services that are medically necessary. The following policy revisions have been posted for review and comment:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS
Allergy and Immunotherapy (TX.CP.MP.100)* *Note that limitations for the provision of professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (CPT 95165) differ by program, (Medicaid/CHIP, Medicare, and Health Insurance Marketplace). A separate policy is posted for each of these programs.	February 1, 2022	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Allwell from Superior HealthPlan – HMO and HMO D-SNP)	Updated policy revisions include: The addition of allergy tests that not considered medically necessary; and Procedure codes considered not medically necessary, as related to allergy testing and immunotherapy; and Updates and addition of diagnosis codes that support the medical necessity of specific allergy testing and immunotherapy services.

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW OR UPDATED POLICY REVISIONS

Allergy and Immunotherapy (TX.CP.MP.100)*

*Note that limitations for the provision of professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (CPT 95165) differ by program, (Medicaid/CHIP, Medicare, and Health Insurance Marketplace). A separate policy is posted for each of these programs.

February 1, 2022

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan, Medicare (Allwell from Superior HealthPlan – HMO and HMO D-SNP)

Updated policy revisions include:

The addition of allergy tests that not considered medically necessary; and
Procedure codes considered not medically necessary, as related to allergy testing and immunotherapy; and
Updates and addition of diagnosis codes that support the medical necessity of specific allergy testing and immunotherapy services.

To review all clinical payment policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

Prior to updates, clinical payment policies are reviewed and approved by the Utilization Management Committee.

For questions or additional information, please contact Superior Provider Services at:

1-877-391-5921 (Medicaid [STAR, STAR Health, STAR Kids, STAR+PLUS], CHIP, Allwell from Superior HealthPlan [HMO, HMO SNP])
1-877-687-1196 (Ambetter from Superior HealthPlan)