Allergy Testing and Allergy Immunotherapy
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1 All Panels and individual tests below are billed by CPT Code or contain a component that bills Test Name Allergic Bronchopulmonary Aspergillosis Panel II Allergy Panel 1 Allergy Panel 2 Allergy Panel 3 Almond IgE, Allergen Alpha Lactalbumin IgE, Allergen Alternaria alternata/tenuis IgE, Allergen Amaranth American Beech IgE, Allergen Amoxicillin/Amoxicilloyl IgE, Allergen Ampicillin/Ampicilloyl IgE, Allergen Animal Allergen Panel Apple IgE, Allergen Apricot IgE, Allergen Aspergillus fumigatus IgE, Allergen Aspergillus IgE Panel Aspergillus niger IgE, Allergen Aubergine Eggplant, IgE Allergen Aureobasidium Pullulans IgE, Allergen Avocado IgE, Allergen Bahia Grass IgE, Allergen Banana IgE, Allergen Barley IgE, Allergen Basil IgE, Allergen Beef IgE, Allergen Bermuda Grass IgE, Allergen Black Pepper IgE, Allergen Blackberry IgE, Allergen Blue Mussel IgE, Allergen Blueberry IgE, Allergen Box Elder IgE, Allergen Brazil Nut IgE, Allergen Broccoli IgE, Allergen Bumble Bee Venom IgE, Allergen Cabbage IgE, Allergen Cacao (Chocolate) IgE, Allergen Test Code FWP1 FWP2 FWP3 AG46 AG66 AG19 AG91 AG145 AG146 ANIM AG47 AG187 AG20 ASGE AG150 AG196 AG27 AG201 AG11 AG48 AG49 AG119 AG50 AG12 AG144 AG194 AG151 AG156 AG94 AG130 AG166 AG10 AG206 AG57
2 Candida albicans IgE, Allergen Carmine Carrot IgE, Allergen Casein IgE, Allergen Cashew Nut IgE, Allergen Cat Epithelium/Dander IgE, Allergen Cauliflower IgE, Allergen Cedar IgE, Allergen Celery IgE, Allergen Cephalosporin IgE, Allergen Cheese Mold Type IgE, Allergen Cheese, Cheddar Type IgE, Allergen Chicken Feathers IgE, Allergen Chicken Meat IgE, Allergen Childhood Allergy Panel Cinnamon IgE, Allergen Cladosporium herbarum IgE, Allergen Clam IgE, Allergen Cocklebur IgE, Allergen Cocksfoot (Orchard Grass) IgE, Allergen Coconut IgE, Allergen Codeine IgE, Allergen Codfish IgE, Allergen Coffee IgE, Allergen Common Ragweed, IgE Allergen Common Silver Birch IgE, Allergen Corn (Pollen) IgE, Allergen Corn IgE, Allergen Cotton Seed IgE, Allergen Cottonwood IgE, Allergen Cow Dander IgE, Allergen Cow Milk IgE, Allergen Crab IgE, Allergen Cranberry IgE, Allergen Cucumber IgE, Allergen Curry IgE, Allergen Dermatophagoides farinae IgE, Allergen Dermatophagoides pteronyssinus IgE, Allergen Dill IgE, Allergen Dog Dander IgE, Allergen AG21 AG51 AG52 AG53 AG1 AG184 AG198 AG54 AG167 AG55 AG2 AG56 CHAP1 AG169 AG22 AG58 AG32 AG16 AG161 AG59 AG171 AG108 AG92 AG60 AG178 AG95 AG162 AG69 AG61 AG170 AG168 AG126 AG29 AG30 AG121 AG105
3 Duck Feathers IgE, Allergen Dust Allergen Panel Eastern Midwest Panel Egg White IgE, Allergen Egg Whole IgE, Allergen Egg Yolk IgE, Allergen Elm IgE, Allergen Erythromycin IgE, Allergen False Ragweed IgE, Allergen Fire Ant IgE, Allergen Firebush, Kochia IgE, Allergen Flounder IgE, Allergen Food Allergy Panel Food Panel 2 Galactose-alpha-1,3-galactose IgE Garlic IgE, Allergen German Cockroach IgE, Allergen Giant Ragweed IgE, Allgergen Ginger IgE, Allergen Gluten IgE, Allergen Goldenrod IgE, Allergen Goose Feathers IgE, Allergen Goosefoot, Lambs Quarters IgE, Allergen Grape IgE, Allergen Grapefruit IgE, Allergen Great Lakes Panel Green Bean IgE, Allergen Green Pepper IgE, Allergen Guinea Pig Epithelium IgE, Allergen Halibut IgE, Allergen Hazel IgE, Allergen Hazel Nut IgE, Allergen Helminthosporium Halodes IgE, Allergen Helminthosporium sativum/drecshlera IgE, Allergen Honey, IgE Allergen Honeybee Venom IgE, Allergen Horse Dander IgE, Allergen House Dust - Hollister Stier IgE, Allergen House Dust-Greer IgE, Allergen Inhalant Panel AG3 DSPNP EMWPP AG106 AG107 AG62 AG96 AG136 AG39 AG9 AG35 AG116 FD10P FDP3 AG63 AG8 AG40 AG124 AG64 AG34 AG4 AG36 AG181 AG207 GLWG AG200 AG183 AG155 AG114 AG177 AG65 AG133 AG23 AG197 AG110 AG5 AG160 AG31 ENTP
4 Isocyanate HDI IgE, Allergen Isocyanate MDI IgE, Allergen Isocyanate TDI IgE, Allergen Johnson Grass IgE, Allergen Kiwi IgE, Allergen Latex IgE Lemon IgE, Allergen Lettuce IgE, Allergen Lima Bean IgE, Allergen Lobster IgE, Allergen Macadamia Nut IgE, Allergen Mackerel IgE, Allergen Malt IgE, Allergen Maple Leaf Sycamore IgE, Allergen Meadow Fescue IgE, Allergen Meadow Grass, Kentucky Blue IgE, Allergen Mold Allergen Panel Mountain Juniper IgE, Allergen Mucor racemosus IgE, Allergen Mugwort IgE, Allergen Mulberry IgE, Allergen Mulberry Red Tree IgE Mushroom (Champignon) IgE, Allergen Mustard Seed IgE, Allegren Mutton IgE, Allergen Nettle IgE, Allergen Nutmeg IgE, Allergen Oak IgE, Allergen Oat IgE, Allergen Occupational Panel Onion IgE, Allergen Orange IgE, Allergen Oregano IgE, Allergen Oyster IgE, Allergen Paper Wasp Venom IgE, Allergen Paprika Sweet Pepper IgE, Allergen Parsley IgE, Allergen Pea IgE, Allergen Peach IgE, Allergen Peanut IgE, Allergen AG142 AG141 AG140 AG13 AG163 LATEX AG204 AG67 AG175 AG68 AG185 AG115 AG180 AG102 AG15 AG14 MLDP AG199 AG25 AG38 AG154 AG165 AG148 AG179 AG153 AG128 AG98 AG70 OCAAC AG71 AG72 AG127 AG117 AG109 AG202 AG129 AG73 AG74 AG75
5 Pear IgE, Allergen Pecan (Hickory) IgE, Allergen Pecan Nut IgE, Allergen Pediatric Allergen Panel Penicillium notatum IgE, Allergen Penicilloyl G IgE, Allergen Penicilloyl V IgE, Allergen Phthalic Anhydride IgE, Allergen Pigweed IgE, Allergen Pine Nut, Pignoles IgE, Allergen Pineapple IgE, Allergen Pinto Bean IgE, Allergen Pistachio IgE, Allergen Plantain (English), Ribwort IgE, Allergen Plum IgE, Allergen Pork IgE, Allergen Potato IgE, Allergen Quinoline Yellow IgE Raspberry IgE, Allergen Red Kidney Bean IgE, Allergen Red Maple Tree IgE, Allergen Redtop Bentgrass IgE, Allergen Region 5 Allergy Panel Respiratory Region V Standard Panel Rhizopus nigricans IgE, Allergen Rice IgE, Allergen Rough Marshelder IgE, Allergen Rye Grass IgE, Allergen Rye IgE, Allergen Sage IgE, Allergen Salmon IgE, Allergen Saltwort, Russian Thistle IgE, Allergen Scallops IgE, Allergen Sesame Seed IgE, Allergen Sheep Epithelium IgE, Allergen Sheep Sorrel IgE, Allergen Shrimp IgE, Allergen Sole IgE, Allergen Soybean IgE, Allergen Stinging Insect Allergen AG186 AG97 AG76 PED AG26 AG134 AG135 AG42 AG131 AG193 AG174 AG132 AG33 AG182 AG77 AG78 AG159 AG172 AG99 AG149 REG5 RESP2 AG28 AG79 AG37 AG17 AG80 AG122 AG81 AG43 AG118 AG147 AG6 AG44 AG82 AG164 AG83 HRNWG
6 Strawberry IgE, Allergen Sugar Beet IgE, Allergen Sugar Maple Tree IgE, Allergen Sulfamethoxazol IgE, Allergen Summer Squash IgE, Allergen Sweet Potato IgE, Allergen Tartrazine Tetracycline IgE, Allergen Thyme IgE, Allergen Timothy Grass IgE, Allergen Tomato IgE, Allergen Tree Allergen Panel Tuna IgE, Allergen Turkey Meat IgE, Allergen Virginia Live Oak IgE, Allergen Walnut IgE, Allergen Walnut Tree Pollen IgE, Allergen Weed Allergen Panel 5 Western Ragweed IgE, Allergen Wheat IgE, Allergen Whey IgE, Allergen White Ash IgE, Allergen White Bean IgE, Allergen White Pine IgE, Allergen White-Faced Hornet Venom IgE, Allergen Willow IgE, Allergen Wormwood IgE, Allergen Yeast (Bakers/Brewers) IgE, Allergen Yellow Hornet Venom IgE, Allergen Yellow Jacket Venom IgE, Allergen Yellow Wax Bean IgE, Allergen AG84 AG205 AG216 AG139 AG195 AG138 AG123 AG18 AG85 TREPG AG86 AG87 AG24 AG88 AG93 WEDPP AG41 AG89 AG157 AG103 AG173 AG101 AG111 AG104 AG45 AG90 AG112 AG113 AG176 Utilization Guideline Allergy testing LCD s are broken down based on CPT. All of our allergens use CPT so these are the ICD-9 codes that will meet medical necessity and can be listed in the test directory.
7 CPT code will be covered only twenty four (24) times in a year, up to two (2) panels a year contain up to twelve (12) each panel. Services exceeding this parameter will be considered not medically necessary. Narrative Description ICD9 ASPERGILLOSIS OTHER ATOPIC DERMATITIS AND RELATED CONDITIONS ALLERGIC URTICARIA DERMATOGRAPHIC URTICARIA TOXIC EFFECT OF VENOM TOXIC EFFECT OF LATEX OTHER ANAPHYLACTIC REACTION ANAPHYLACTIC REACTION DUE TO UNSPECIFIED FOOD ANAPHYLACTIC REACTION DUE TO PEANUTS ANAPHYLACTIC REACTION DUE TO CRUSTACEANS ANAPHYLACTIC REACTION DUE TO FRUITS AND VEGETABLES ANAPHYLACTIC REACTION DUE TO TREE NUTS AND SEEDS ANAPHYLACTIC REACTION DUE TO FISH ANAPHYLACTIC REACTION DUE TO FOOD ADDITIVES ANAPHYLACTIC REACTION DUE TO MILK PRODUCTS ANAPHYLACTIC REACTION DUE TO EGGS ANAPHYLACTIC REACTION DUE TO OTHER SPECIFIED FOOD OTHER FOLLOW-UP EXAMINATION V67.59
8 Allergy Testing Testing ICD Codes Numerical Order V67.59
Allergen Testing Performed at St. Louis Children s Hospital
Allergen Testing Performed at St. Louis Children s Hospital Almond Allergen Alternaria Tenuis Allergen American Beech Allergen Apple Allergen Apricot Allergen Asparagus Allergen KIDDOS Order Name Aspergillus
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Allergology product list 2018
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ALLERGEN TEST REQUEST FORM Department of Laboratories St. Louis, Missouri 63110
Date} NAME ADDRESS ACCOUNT INFORMATION PHONE ORDERING PHYSICIAN BILL TO: 9 ACCOUNT 9 PATIENT/INSURANCE 9 ALTERNATE SEND ADDITIONAL COPY OF REPORT TO: CLIENT NUMBER/PHYSICIAN NAME PHONE/FAX NUM. PHYSICIAN
Sample results. Actual results may vary. PATIENT INFORMATION DOB: AGE: GENDER: FASTING: Clinical Info: Test Name Result Flag Reference Range Lab
Sample results. Actual results may vary. SPECIMEN INFORMATION SPECIMEN: REQUISITION: LAB REF NO: PATIENT INFORMATION DOB: AGE: GENDER: FASTING: REPORT STATUS: FINAL ORDERING PHYSICIAN CLIENT INFORMATION
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LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH GENDER PHYSICIAN ID. TESTNAME PATIENT Female For doctor's reference
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588-Complete Dietary Antigen Testing
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Allergy Testing ALLERGY TESTING. 0.3 ml Serum, Red-Top Tube, no additive (Preferred), Serum separator tube (Acceptable) PER ALLERGEN; Minimum 0.
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SPECIMEN COLLECTED: SPECIMEN RECEIVED: LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH GENDER PHYSICIAN ID. City: SAN CARLOS State: CA.
FINAL REPORT DATE: 6- - 7 9: SPECIMEN COLLECTED: - - ACCESSION ID: SPECIMEN RECEIVED: - - : LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH GENDER PHYSICIAN ID TESTNAME PATIENT 98 - - Male 99999 PATIENT
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REAGENTS AND MATERIALS This test kit contains sufficient wells and reagents to assay the serum of 3 patients for antibodies to 90 different foods.
INTENDED USE This kit is for measuring the relative amount of food-specific IgG antibody in human serum. The values obtained must always be correlated with the clinical presentation, since elevation of
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