UHC: NY Community plan: Allergy testing limits

Effective May 1, 2021, the UHC community plan of NY will set 5-year frequency limits on some allergy testing codes. To know the codes, read along!

UHC community plan of NY is pacing 5-year frequency limits on the following Allergy testing codes:

     CPT code                          # of tests covered in a 5-year period

• 95004                            60
• 95017                            60
• 95018                            60
• 95024                            40
• 95027                            40
• 95028                            40
• 95044                            40
• 96003                            30

When a code is billed with units exceeding the stated maximum, the units will be denied. The effective date for this update is May 1, 2021 (by date of service).

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medicaid-comm-plan-reimbursement/community-plan-reimbursement-update-bulletin-february-2021.pdf