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24.3.2 Allergy Services
The following services are benefits of the CSHCN Services Program:
• A total component for radioallergosorbent (RAST) testing when used to detect latex sensitivity only.
•Antibiotic allergy testing and desensitization performed by a physician or advanced practice nurse (APN).
To provide Medicaid services, each nurse practitioner (NP) or clinical nurse specialist (CNS) must be licensed as a registered nurse and recognized as an APN by the Texas Board of Nursing (BON).
Antibiotic desensitization therapy allows the physician to utilize a specific antibiotic for medical management of a client who has developed an allergy to the antibiotic. Desensitization prevents the necessity of changing to a different, perhaps less effective, or more expensive antibiotic.
Antibiotic desensitization therapy for other diagnoses may be considered with documentation supporting medical necessity.
Allergy testing is paid on a per test basis. Providers must indicate the number of tests provided in the Units field of the CMS-1500 claim form. If the number of tests is not indicated in this field, payment is made for only one test.
Use procedure codes 5-86003, 1-95010, 1-95015, and 1-95180 to bill for allergy testing and desensitization, and latex allergy testing.
Providers performing latex allergy testing in their office should add the modifier PO indicating that they have the appropriate equipment in their office to perform the test. Latex sensitivity testing is limited to 12 times per rolling year.
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