Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
| Contract | Contractor | Type | States |
|---|---|---|---|
| 06101 | Wellpoint Federal | MAC - Part A | IL |
| 06201 | Wellpoint Federal | MAC - Part A | MN |
| 06301 | Wellpoint Federal | MAC - Part A | WI |
| 06102 | Wellpoint Federal | MAC - Part B | IL |
| 06202 | Wellpoint Federal | MAC - Part B | MN |
| 06302 | Wellpoint Federal | MAC - Part B | WI |
| 13101 | Wellpoint Federal | A and B and HHH MAC | CT |
| 13201 | Wellpoint Federal | A and B and HHH MAC | NY |
| 13102 | Wellpoint Federal | A and B and HHH MAC | CT |
| 13202 | Wellpoint Federal | A and B and HHH MAC | DN |
| 13282 | Wellpoint Federal | A and B and HHH MAC | UN |
| 13292 | Wellpoint Federal | A and B and HHH MAC | QN |
| 14411 | Wellpoint Federal | A and B and HHH MAC | RI |
| 14211 | Wellpoint Federal | A and B and HHH MAC | MA |
| 14311 | Wellpoint Federal | A and B and HHH MAC | NH |
| 14511 | Wellpoint Federal | A and B and HHH MAC | VT |
| 14111 | Wellpoint Federal | A and B and HHH MAC | ME |
| 14112 | Wellpoint Federal | A and B and HHH MAC | ME |
| 14212 | Wellpoint Federal | A and B and HHH MAC | MA |
| 14312 | Wellpoint Federal | A and B and HHH MAC | NH |
| 14512 | Wellpoint Federal | A and B and HHH MAC | VT |
| 14412 | Wellpoint Federal | A and B and HHH MAC | RI |
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56844 (Billing and Coding: RAST Type Tests) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A56844: Billing and Coding: RAST Type Tests (Billing and Coding, effective 2026-04-01)
- Covered ICD-10-CM codes
- 1008
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 4
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| J30.0 | — |
| J30.1 | — |
| J30.2 | — |
| J30.5 | — |
| J30.81 | — |
| J30.89 | — |
| J30.9 | — |
| J45.20 | — |
| J45.21 | — |
| J45.22 | — |
| J45.30 | — |
| J45.31 | — |
| J45.32 | — |
| J45.40 | — |
| J45.41 | — |
| J45.42 | — |
| J45.50 | — |
| J45.51 | — |
| J45.52 | — |
| J45.901 | — |
| J45.902 | — |
| J45.909 | — |
| J45.991 | — |
| J45.998 | — |
Procedure codes: 86001, 86003, 86005, 86008.
Coverage indications, limitations and medical necessity
Abstract:
Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous tests are in vitro techniques for determining whether a patient's serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient.
The multiple antigen simultaneous testing technique is similar to the RAST/FAST techniques in that it depends upon the existence of allergic antibodies in the blood of the patient being tested. With the multiple antigen simultaneous test system, several antigens may be used to test for specific IgE simultaneously.
ELISA (enzyme-linked immunosorbent assay) is another in vitro method of allergy testing for specific IgE antibodies against allergens. This method is also a variation of RAST.
Limitations:
The following tests are considered to be not medically necessary and will be denied.
• ELISA/Act qualitative antibody testing
This testing is used to determine in vitro reaction to various foods and relies on lymphocyte blastogenesis in response to certain food antigens.
• LMRA (Lymphocyte Mitogen Response Assays) by ELISA/Act
• IgG ELISA, indirect method
• Qualitative multi-allergen screen
This is a non-specific test that does not identify a specific antigen.
• IgG and IgG subclass antibody tests for food allergy do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed.
Summary of evidence (opening)
N/A
the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2015-10-01
- Current revision effective
- 2026-04-01
- Last reviewed by the contractor
- 2017-12-13
- MCD version
- 19
- Derived from
- L28463
The contractor lists 3 National Coverage Determinations as related: NCD 110.11 Food Allergy Testing and Treatment, NCD 110.12 Challenge Ingestion Food Testing, NCD 110.13 Cytotoxic Food Tests. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Wellpoint Federal hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L33591 cover?
Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous tests are in vitro techniques for determining whether a patient's serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L33591 apply to?
Wellpoint Federal applies it to Medicare claims in CT, DN, IL, MA, ME, MN, NH, NY, QN, RI, UN, VT, WI. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L33591?
The companion billing and coding article A56844 lists 1,008 ICD-10-CM codes in 1 group that support medical necessity; the first 24 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L33591?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.