Blood test measuring IgE antibodies to a single allergen extract, reported once per allergen tested.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- History of the reaction prompting the test
- List of each allergen tested
- Unit count matching the allergens listed
- Planned surgery or exposure the result affects
- Lab report with individual results
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
Allergen-specific IgE is an allergy test, billed one unit per allergen, but ortho practices run into it in a few places. The most common is a suspected latex allergy before surgery, where a latex-specific IgE helps decide whether the case needs a latex-safe room. It can also come up when a patient reports reactions to a drug or material and the anesthesiologist or allergist wants objective data.
It does not test for metal allergy to implants. Nickel and cobalt sensitivity is delayed-type hypersensitivity, checked by patch testing or lymphocyte transformation testing, not IgE. Billing 86003 for a "metal allergy panel" before a knee replacement is a common mistake.
Units matter. Each allergen is one unit, and payers set unit limits per date of service. Document every allergen tested and why. Allergen mixes and component testing have different codes.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 86003 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Units exceed payer limits per date
- Billed for metal implant allergy testing
- No documented reaction history
- Allergen mix billed as individual allergens
- Screening without symptoms
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Can 86003 test for metal implant allergy?
02How many units of 86003 can I bill?
03Is a latex IgE test billed with 86003?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the patient's reaction history in detail, so allergy testing before surgery has the history a payer looks for.
See how Mira captures CPT 86003 documentation