Limiting allergenic extract

October 17, 2016

The Advocacy Council has been alerted to an issue that seems to be involving more and more states – extremely low limits of allergenic extract (95165) units being reimbursed both annually and per date of service per claim – for Medicaid and private insurers. We have been successful in addressing these policies in several states (Michigan, Arkansas, Kentucky) and are working with allergy leaders in other states on this problem right now! (Washington state, Nebraska, North Carolina)

If allergists in your state are being denied reimbursement because of a policy setting low limits on the number of allergenic extract units per claim or annually, contact the Advocacy Council at AdvocacyCouncil@ACAAI.org or 847-427-1200 – we’re here for you!

JUST IN!  CIGNA Revises Policy Regarding CPT 95165

CIGNA insurance implemented restrictions on the number of doses of allergenic extract for which they will reimburse allergists. Through the work of the Advocacy Council of ACAAI, CIGNA has revised its policy (effective 2/15/16) to include less restrictive guidance, and increased the limits to 150 units per year. We appreciate CIGNA’s willingness to consider our request and look forward to a long relationship on which we can continue to collaborate for reasonable policy guidance. Read the entire CIGNA policy change for further information.