Allergy Testing and Therapy Policy Update - Effective 11/01/20

Date: 08/05/20

Superior HealthPlan will be incorporating revisions to its Allergy Testing and Therapy Policy. For details and applicable requirements related to the proposed policy revisions, please review the policies linked in the table below for each applicable product.

Policy Number/Name	Effective Date	Applicable Products	New Policy Overview or Updated Policy Revisions	Policy Link
TX.CP.MP.100 Allergy Testing and Therapy	11/01/20	Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) CHIP, Allwell from Superior HealthPlan (Medicare) and Ambetter from Superior HealthPlan (Marketplace)	Policy revision to annual unit limitations for professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (CPT 95165): Medicaid/CHIP: 160 units/year Marketplace: 120 units/year Medicare: No annual unit limitation	Allergy Testing and Therapy (TX.CP.MP.100) – Medicaid/CHIP Allergy Testing and Therapy (TX.CP.MP.100) – Medicare Allergy Testing and Therapy (TX.CP.MP.100) – Marketplace

Policy Number/Name

Effective Date

Applicable Products

New Policy Overview or Updated Policy Revisions

Policy Link

TX.CP.MP.100

Allergy Testing and Therapy

11/01/20

Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) CHIP, Allwell from Superior HealthPlan (Medicare) and Ambetter from Superior HealthPlan (Marketplace)

Policy revision to annual unit limitations for professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (CPT 95165):

Medicaid/CHIP: 160 units/year

Marketplace: 120 units/year

Medicare: No annual unit limitation

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

For questions or additional information, please contact your local Account Manager.