Does Z91.0120 require prior authorization?

No, Z91.0120 does not require prior authorization (high confidence). Covered without prior authorization.

`Z91.0120`, Allergy to eggs, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When a referring or ordering physician is required, the claim must report the name and NPI of the referring/ordering physician.
For diagnostic tests, the claim should report the test result if known; if result is not known, report the symptoms prompting the test and include a valid ICD-10-CM diagnosis code that best describes the patient's condition.
The patient medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
When an ABN is used, Form CMS-R-131 should be signed by the beneficiary (or properly witnessed if the beneficiary refuses to sign); for claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN are required.

CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.

CGS-J15-L34063, RAST Type Tests

J15

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L34063, RAST Type Tests

J18

CGS-J18-L40325, Allergy Diagnostic Testing

J18

A57473, Billing and Coding: Allergy Testing

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